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Avastin Reduces Brain Necrosis from Radiation

Al's Comment:

 This is an exciting article.. it says that using Avastin in combination with stereotactic radiosurgery greatly reduces the chances of developing radiation necrosis from 50% to 3-6%, and almost doubles the average survival!


Disclaimer: Genetech - the makers of Avastin - are a sponsor of our organization! 

Posted on: 11/13/2012

Avastin Reduces Brain Necrosis from Radiation

By Ed Susman, Contributing Writer, MedPage Today
Published: October 30, 2012
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points
This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
In this retrospective study, the use of concurrent and/or adjuvant bevacizumab with stereotactic radiosurgery for recurrent high grade gliomas appeared to be associated with a lower risk of developing radiation necrosis and improved overall survival.
BOSTON -- Patients who have radiation treatment following surgery for brain cancer may have less radiation-induced tissue necrosis if they are also treated with bevacizumab (Avastin), researchers reported here.

Six percent of patients treated with adjuvant bevacizumab and 3% of those who received concurrent bevacizumab developed tissue necrosis versus half of the patients who did not receive bevacizumab (P<0.001), said Kyle Cuneo, MD, radiation oncologist at the University of Michigan School of Medicine, Ann Arbor.

"Bevacizumab is associated with a lower risk of radiation necrosis in patients receiving stereotactic surgery for recurrent glioma," said Cuneo in his oral presentation as the American Society for Radiation Oncology. "The mechanism behind this effect is unknown."

What is known, he said, is that "there is a high risk of radiation necrosis after stereotactic surgery for glioblastoma multiforme."

He said less successful attempts to prevent necrosis have included the use of hyperbaric oxygen, vitamin E, or use of heparin or warfarin.

The researchers also determined that 57% of patients who received concurrent bevacizumab achieved 1-year overall survival; 59% who received adjuvant bevacizumab survived at least a year and 38% of patients not receiving bevacizumab had a 1-year survival.

Patients who received bevacizumab achieved a median overall survival of 13.5 months versus 7.2 months in patients not receiving bevacizumab (P=0.035).

The researchers analyzed outcomes in 102 patients who underwent previous partial brain radiation with temozolomide (Temodar) and had stereotactic surgery at Duke University Medical Center. Cuneo was affiliated with Duke before moving to a faculty position at Michigan. Radiation necrosis was diagnosed by biopsy or by two imaging modalities. The time to diagnosed recurrence was 19 to 22 months.

Concurrent bevacizumab was administered to 58 patients with a median age of 53 years; adjuvant bevacizumab was administered to 21 patients with a median age of 47 years; no bevacizumab was given to 23 patients with a median age of 53. The difference in age was not significant (P=0.49).

Compared with bevacizumab-treated patients, more patients who did not receive bevacizumab had performance status less than 80 -- 8 patients versus 4 in the concurrent arm and 3 in the adjuvant arm (P=0.001). All other treatment variables were not statistically different.

In responding to questions from the audience, Cuneo said he believes that the necrosis causing concern is more likely healthy brain tissue affected by radiation rather than cancer cell destruction.

"Findings from this study need to be confirmed," he said, noting the limitations for generalization of the results due to its retrospective nature.

Arnab Chakravarti, MD, chair and professor of radiation oncology, and the Max Morehouse chair of cancer research at the James Comprehensive Cancer Center at Ohio State University, Columbus, who was the invited discussant for the oral presentation session, told MedPage Today, "I think that bevacizumab as a non-steroidal anti-inflammatory drug can reduce toxicity from radiation and radiation-induced temozolomide and that might be the optimal indication for it in this setting.

"Nonsteroidals tend to reduce the amount of swelling edema, Necrosis has a lot of different components to it and I think bevacizumab can have an impact on it and if not necrosis itself, on the edema affecting the surrounding tissue."

Cuneo and Chakravarti had no disclosures. Co-authors included employees of Genentech.

Primary source: International Journal of Radiation Oncology - Biology - Physics


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