PDF(Pubmed)
Abstract：
Patients with solid tumor brain metastases that progress after whole-brain radiation have limited options. This prospective trial investigated the efficacy, safety, and tolerability of bevacizumab as salvage therapy in this population. Eligible patients received bevacizumab 10 mg/kg intravenously every 2 weeks until progression. The primary endpoint was radiologic response using Response Assessment in Neuro-Oncology (RANO) criteria. The secondary endpoints were progression-free survival (PFS), overall survival (OS), duration of response, and safety. Quality of life (QOL) was studied using the Functional Assessment of Cancer Therapy-Brain (FACT-Br) scale. Twenty-seven patients were enrolled, with twenty-four having evaluable data for response. The majority of histologies (n = 21, 78%) were breast cancer. The remaining histologies were non-small-cell lung cancer (n = 4, 15%), neuroendocrine cancer (n = 1, 3%), and papillary fallopian serous adenocarcinoma (n = 1, 3%). Eighteen patients had radiologic response, with two patients demonstrating partial response (8.33%) and sixteen patients demonstrating stable disease (66.7%). The median duration of response was 203 days. PFS at 6 months was 46%, median PFS was 5.3 m, and median OS was 9.5 m. Treatment was well tolerated, with six patients experiencing grade 3 lymphopenia and hypertension. There was one grade 3 thromboembolism. QOL was not negatively impacted. Bevacizumab is a safe and feasible salvage treatment with durable response and favorable overall survival for patients with progressive brain metastases after whole-brain radiation.
摘要：
全脑放疗后进展的实体瘤脑转移患者的选择有限。这项前瞻性试验调查了疗效，安全,和贝伐单抗作为挽救治疗在该人群中的耐受性。符合条件的患者每2周静脉内接受10mg/kg贝伐单抗直至进展。主要终点是使用神经肿瘤学反应评估（RANO）标准的放射学反应。次要终点是无进展生存期（PFS），总生存期（OS），响应的持续时间，和安全。使用癌症治疗脑功能评估（FACT-Br）量表研究生活质量（QOL）。27名患者入选，24个有可评估的反应数据。大多数组织学（n=21，78％）是乳腺癌。其余组织学是非小细胞肺癌（n=4，15％），神经内分泌癌（n=1，3％），和乳头状输卵管浆液性腺癌（n=1，3％）。18名患者有放射学反应，其中2例患者显示部分缓解（8.33%），16例患者显示病情稳定（66.7%）。响应的中位持续时间为203天。6个月时的PFS为46％，中位PFS为5.3m，中位OS为9.5m。治疗耐受性良好，6例患者出现3级淋巴细胞减少和高血压。有一次3级血栓栓塞。QOL没有受到负面影响。贝伐单抗是一种安全可行的挽救治疗方法，对于全脑放疗后进行性脑转移患者具有持久的反应和良好的总体生存率。
