title: Bevacizumab for Patients with Recurrent Gliomas Presenting with a Gliomatosis Cerebri Growth Pattern.
abstract: Bevacizumab has been shown to improve progression-free survival and neurologic function, but failed to improve overall survival in newly diagnosed glioblastoma and at first recurrence. Nonetheless, bevacizumab is widely used in patients with recurrent glioma. However, its use in patients with gliomas showing a gliomatosis cerebri growth pattern is contentious. Due to the marked diffuse and infiltrative growth with less angiogenic tumor growth, it may appear questionable whether bevacizumab can have a therapeutic effect in those patients. However, the development of nodular, necrotic, and/or contrast-enhancing lesions in patients with a gliomatosis cerebri growth pattern is not uncommon and may indicate focal neo-angiogenesis. Therefore, control of growth of these lesions as well as control of edema and reduction of steroid use may be regarded as rationales for the use of bevacizumab in these patients. In this retrospective patient series, we report on 17 patients with primary brain tumors displaying a gliomatosis cerebri growth pattern (including seven glioblastomas, two anaplastic astrocytomas, one anaplastic oligodendroglioma, and seven diffuse astrocytomas). Patients have been treated with bevacizumab alone or in combination with lomustine or irinotecan. Seventeen matched patients treated with bevacizumab for gliomas with a classical growth pattern served as a control cohort. Response rate, progression-free survival, and overall survival were similar in both groups. Based on these results, anti-angiogenic therapy with bevacizumab should also be considered in patients suffering from gliomas with a mainly infiltrative phenotype.
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, Goethe University, 60528 Frankfurt, Germany. michael.burger@kgu.de.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Burger
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, Goethe University, 60528 Frankfurt, Germany. iris.mildenberger@umm.de.
authors.forename: Iris C
authors.initials: IC
authors.lastname: Mildenberger
authors.affiliation: Institute of Neuroradiology, Goethe University, 60528 Frankfurt, Germany. Marlies.Wagner@kgu.de.
authors.forename: Marlies
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Luxembourg Centre of Neuropathology (LCNP), 3555 Dudelange, Luxembourg. michel.mittelbronn@lns.etat.lu.|Laboratoire National de Santé, 3555 Dudelange, Luxembourg. michel.mittelbronn@lns.etat.lu.|Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 4362 Esch-sur-Alzette, Luxembourg. michel.mittelbronn@lns.etat.lu.|NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health (L.I.H.), 1526 Luxembourg, Luxembourg. michel.mittelbronn@lns.etat.lu.|Institute of Neurology (Edinger Institut), Goethe University, 60528 Frankfurt, Germany. michel.mittelbronn@lns.etat.lu.
authors.forename: Michel
authors.initials: M
authors.lastname: Mittelbronn
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, Goethe University, 60528 Frankfurt, Germany. joachim.steinbach@med.uni-frankfurt.de.
authors.forename: Joachim P
authors.initials: JP
authors.lastname: Steinbach
authors.affiliation: Dr. Senckenberg Institute of Neurooncology, Goethe University, 60528 Frankfurt, Germany. oliver.baehr@med.uni-frankfurt.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bähr
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab
keywords: anti-angiogenic therapy; bevacizumab; glioblastoma; glioma; gliomatosis cerebri growth pattern; primary brain tumors