title: Tumor angiogenic and hypoxic profiles predict radiographic response and survival in malignant astrocytoma patients treated with bevacizumab and irinotecan.
abstract: OBJECTIVE
  The combination of a vascular endothelial growth factor (VEGF) -neutralizing antibody, bevacizumab, and irinotecan is associated with high radiographic response rates and improved survival outcomes in patients with recurrent malignant gliomas. The aim of these retrospective studies was to evaluate tumor vascularity and expression of components of the VEGF pathway and hypoxic responses as predictive markers for radiographic response and survival benefit from the bevacizumab and irinotecan therapy.
  
  
  METHODS
  In a phase II trial, 60 patients with recurrent malignant astrocytomas were treated with bevacizumab and irinotecan. Tumor specimens collected at the time of diagnosis were available for further pathologic studies in 45 patients (75%). VEGF, VEGF receptor-2, CD31, hypoxia-inducible carbonic anhydrase 9 (CA9), and hypoxia-inducible factor-2alpha were semiquantitatively assessed by immunohistochemistry. Radiographic response and survival outcomes were correlated with these angiogenic and hypoxic markers.
  
  
  RESULTS
  Of 45 patients, 27 patients had glioblastoma multiforme, and 18 patients had anaplastic astrocytoma. Twenty-six patients (58%) had at least partial radiographic response. High VEGF expression was associated with increased likelihood of radiographic response (P = .024) but not survival benefit. Survival analysis revealed that high CA9 expression was associated with poor survival outcome (P = .016).
  
  
  CONCLUSIONS
  In this patient cohort, tumor expression levels of VEGF, the molecular target of bevacizumab, were associated with radiographic response, and the upstream promoter of angiogenesis, hypoxia, determined survival outcome, as measured from treatment initiation. Validation in a larger clinical trial is warranted.
authors.affiliation: Department of Medicine, Duke University Medical Center, DUMC 2900, Durham, NC 27710, USA.
authors.forename: Sith
authors.initials: S
authors.lastname: Sathornsumetee
authors.forename: Yiting
authors.initials: Y
authors.lastname: Cao
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Marcello
authors.forename: James E
authors.initials: JE
authors.lastname: Herndon
authors.forename: Roger E
authors.initials: RE
authors.lastname: McLendon
authors.forename: Annick
authors.initials: A
authors.lastname: Desjardins
authors.forename: Henry S
authors.initials: HS
authors.lastname: Friedman
authors.forename: Mark W
authors.initials: MW
authors.lastname: Dewhirst
authors.forename: James J
authors.initials: JJ
authors.lastname: Vredenburgh
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Rich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D000068258:Bevacizumab; D014408:Biomarkers, Tumor / Q000032:analysis; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D000860:Hypoxia; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D016016:Proportional Hazards Models; D011859:Radiography; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014408:Biomarkers, Tumor; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000077146:Irinotecan; D002166:Camptothecin