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Recursos del Cáncer > Notícias sobre Cáncer > 2009 > noviembre
Tumor pattern after treatment failure predicts glioblastoma prognosis
Will Boggs, MD
Last Updated: 2009-11-05 15:54:56 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A nonenhancing tumor pattern of progression after treatment with bevacizumab for recurrent glioblastoma is associated with worse survival, according to a report in the November 13th Neurology.
"In selected patients, it may be reasonable to reserve bevacizumab for treatment of a second or later glioblastoma recurrence, because clearly effective post-bevacizumab therapies are lacking," Dr. Andrew B. Lassman from Memorial Sloan-Kettering Cancer Center, New York told Reuters Health. "Such patients might include those without significant contrast enhancing tumor or vasogenic edema and younger patients with good performance status."
Dr. Lassman and colleagues evaluated the patterns of relapse and outcome, as well as the effect of subsequent treatment, in 37 patients with glioblastoma after tumor progression on bevacizumab.
Thirty-two of the patients received bevacizumab at first recurrence, and 5 patients were treated with bevacizumab at second recurrence.
The median overall survival after tumor progression on bevacizumab was 4.5 months, the authors report, and the median follow-up of the only 3 surviving patients was 6 months.
About a third of the patients (35%) showed a pattern of increased nonenhancing tumor with decreased or stable enhancing disease on glioblastoma progression.
"This pattern differs from that typically observed," the investigators say, "in which worsening enhancement at the initial site of disease occurs in 90% to 95% of patients who do not receive bevacizumab."
Among the 19 patients who received salvage chemotherapy after discontinuing bevacizumab, all had tumor progression and 16 died. Their median progression-free survival was 2 months, and no patient had progression-free survival extending to 6 months.
Median survival was similar for the 15 patients who received only supportive care after discontinuing bevacizumab.
In 2 patients whose tumor samples were analyzed at diagnosis, after initial therapy before bevacizumab, and from resection after bevacizumab, there was no increase in VEGFR2 expression after bevacizumab, but there were marked increases in the hypoxia markers HIF-1alpha and CA9 at the time of bevacizumab failure compared with the tumor tissue before bevacizumab exposure.
"Bevacizumab is effective for many patients with recurrent glioblastoma," Dr. Lassman said. "Benefit in patients with other glioma subtypes and patients with newly diagnosed disease is an area of important research, and ongoing clinical trials are designed to assess the efficacy and safety in such populations."
Neurology 2009;73:1200-1206.
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