title: Addition of Anti-Angiogenetic Therapy with Bevacizumab to Chemo- and Radiotherapy for Leptomeningeal Metastases in Primary Brain Tumors.
abstract: Leptomeningeal dissemination of a primary brain tumor is a condition which is challenging to treat, as it often occurs in rather late disease stages in highly pretreated patients. Its prognosis is dismal and there is still no accepted standard of care. We report here a good clinical effect with a partial response in three out of nine patients and a stable disease with improvement on symptoms in two more patients following systemic anti-angiogenic treatment with bevacizumab (BEV) alone or in combination with chemo- and/or radiotherapy in a series of patients with leptomeningeal dissemination from primary brain tumors (diffuse astrocytoma WHO°II, anaplastic astrocytoma WHO°III, anaplastic oligodendroglioma WHO°III, primitive neuroectodermal tumor and glioblastoma, both WHO°IV). This translated into effective symptom control in five out of nine patients, but only moderate progression-free and overall survival times were reached. Partial responses as assessed by RANO criteria were observed in three patients (each one with anaplastic oligodendroglioma, primitive neuroectodermal tumor and glioblastoma). In these patients progression-free survival (PFS) intervals of 17, 10 and 20 weeks were achieved. In three patients (each one with diffuse astrocytoma, anaplastic astrocytoma and primitive neuroectodermal tumor) stable disease was observed with PFS of 13, 30 and 8 weeks. Another three patients (all with glioblastoma) were primary non-responders and deteriorated rapidly with PFS of 3 to 4 weeks. No severe adverse events were seen. These experiences suggest that the combination of BEV with more conventional therapy schemes with chemo- and/or radiotherapy may be a palliative treatment option for patients with leptomeningeal dissemination of brain tumors.
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, Goethe University, Frankfurt, Germany.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Burger
authors.affiliation: Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany.|Department of Neurology, Goethe University, Frankfurt, Germany.
authors.forename: Pia S
authors.initials: PS
authors.lastname: Zeiner
authors.affiliation: Department of Neurology, Goethe University, Frankfurt, Germany.
authors.forename: Kolja
authors.initials: K
authors.lastname: Jahnke
authors.affiliation: Institute of Neuroradiology, Goethe University, Frankfurt, Germany.
authors.forename: Marlies
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany.
authors.forename: Michel
authors.initials: M
authors.lastname: Mittelbronn
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, Goethe University, Frankfurt, Germany.
authors.forename: Joachim P
authors.initials: JP
authors.lastname: Steinbach
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D000068258:Bevacizumab / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009389:Neovascularization, Pathologic / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D000068258:Bevacizumab