Bevacizumab for recurrent malignant gliomas: efficacy, toxicity, and patterns of recurrence.

摘要: I congratulate Norden et al. for their report of 55 patients with recurrent high-grade gliomas treated chemotherapy (85% irinotecan or CPT-11) and bevacizumab.1–3 Several aspects this merit commentary. 1. Unlike prior reports, 6-month progression free survival was best glioblastoma (GBM) vs anaplastic (42% 32%).3 2. The contribution in combination bevacizumab remains unclear. A number reports evaluating CPT-11 as a single agent GBM concluded had little efficacy.4 3. At time progression, continuation resulted feeble response. Escape from anti-vascular endothelial growth factor (VEGF) therapy (bevacizumab) likely represents recruitment compensatory proangiogenic stimuli.5 4. Radiographic assessment response, determined primarily by change the contrast enhancing tumor volume, is problematic antiangiogenic therapies.3,5 Bevacizumab normalizes vascularity resulting loss enhancement, normalization blood volume perfusion, improvement peritumoral edema. As illustrated al., failure initially appears an increase FLAIR signal before re-emergence enhancement. 5. It unclear whether control group similar overall retreatment compared to group, longer associated increased glioma invasiveness. Nonetheless, when comparing these patient groups, no statistically significant incidence diffuse spread seen. 6. Toxicity modest although high deep vein thrombosis pulmonary embolism observed, …