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[Bevacizumab/Irinotecan.
An active treatment for recurrent high grade gliomas: Preliminary results of
an ANOCEF Multicenter Study.]
[Article in
French]
Guiu S, Taillibert S, Chinot O,
Taillandier L, Honnorat J, Dietrich PY, Maire JP,
Guillamo JS, Guiu B, Catry-Thomas I, Capelle F,
Thiebaut A, Cartalat-Carel S, Deville C,
Fumoleau P, Desjardins A, Xuan KH, Chauffert B.
Département
d’oncologie médicale, centre de lutte contre le cancer
Georges-François-Leclerc, 1, rue Professeur Marion, 21000 Dijon, France.
RATIONALE:
Second-line chemotherapy is disappointing in recurrent high-grade gliomas. Dramatic
responses in recurrent high-grade gliomas have been reported in a recent
monocentric trial with a novel association combining bevacizumab (anti-VEGF
monoclonal antibody agent) and irinitecan. OBJECTIVE: To report the
experience of the ANOCEF group (French speaking neuro-oncology association)
using the bevacizumab-irinotecan combination in recurrent high-grade gliomas. METHODS: Eight
centers were involved in this retrospective multicenter study. Bevacizumab-irinotecan was delivered as
previously described in a compassional setting to non-selected
patients suffering from a high-grade glioma (WHO grade III and IV). Response
rate at two months of the onset of the treatment was analyzed using the
Macdonald criteria. The toxicity profile of the treatment was also
investigated. RESULTS: From 2006 to 2007, 77 patients were treated (median
age: 52 years; median Karnofsky score: 70) for a recurrent high-grade glioma
(49 grade IV, 28 grade
III). At two months,
the response rates were
objective response=36%
(54% in grade III and 27% in grade IV);
stable disease=39%;
progressive disease=13%; patients not evaluable because of a rapid fatal
clinical deterioration=12%. Improvement
was noted in 49% of patients. Among the main toxicities, we
noted; intratumoral hemorrage (n=5 with spontaneous regression in three) and
thromboembolic complications including venous thrombophlebitis (n=4),
pulmonary embolism (n=2), myocardial infarction (n=1), grade III-IV
hematotoxicity (n=2), reversible leukoencephalopathy (n=1). CONCLUSION: This retrospective multicenter study adds
further arguments in favor of the promising results of this new combination
and its potential rapidity of action in recurrent high-grade gliomas.
Antiangiogenic agents expose the patients to a well-known risk of
thromboembolic and hemorragic complications, necessitating careful follow-up
and patient selection in light of the cardiovascular contraindications.
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