News Item: Bevacizumab and glioblastoma multiforme
(Category: Misc)
Posted by Ismail
Thursday 02 December 2010 - 21:44:00

Glioblastoma multiforme is the most common brain tumor. According to WHO this Tumor is regarded as highly malignant and poorly visible. The name derives from the Glia "cells" of the brain. Here is also the tumor. The treatment consists of surgical reduction in tumor mass, radiation and chemotherapy.

Bevacizumab

Bevacizumab (Avastin) is an humanized, monoclonal antibody - used to treat patients with age-related macular degeneration in the eye and applied metastatic colon or rectal cancer. This antibody blocks the Vascular Endothelial Growth Factor (VEGF), a growth factor which is responsible for blood vessel formation (angiogenesis). Cancer cells grow more, therefore they need more nutrients and oxygen.

Using Bevacizumab in glioblastoma multiforme?

According to several studies and scientific, bevacizumab applied to the above-mentioned indications, even in recurrent glioblastoma multiforme [1,2]. The FDA (Food and Drug Administration) issued in 2009 multifome accelerated approval for the treatment of glioblastoma with bevacizumab. Even long before the approval, bevacizumab has been used in the U.S. and some European countries to very serious cases of glioblastoma multiforme[2].

Studies and Reviews

In a multicenter, randomized study from New Zealand patients were divided into two groups [1]. In one arm were 85 patients who had previously suffered Glioblastoma the first or second relapse, 2 weeks, bevacizumab at a dose of 10 mg bevacizumab per kilogram. The survival rate for 6 months was 42%. In the second arm 82 patients were given the combination of bevacizumab and irinotecan, here they reached an even higher survival rate of 50.3%. All these data were even better than the historical control data [1].

A better result of the combination of bevacizumab and irinotecan is also confirmed by another study, was in a literature search [2] under the theme "Bevacizumab treatment option for recurrent glioblastoma multiforme" is performed. Thereby, the following databases explored and evaluated: MEDLINE (1966-June 2008), the Cochrane Library and International Pharmaceutical Abstracts (1970-June 2008). It evaluates all information and limited the search to study results in humans. The combination treatment with bevacizumab and irinotecan was glioblastoma multiforme with a view to positive. However, we need now more randomized studies to determine the extent of the benefits of bevacizumab determine more accurately.

Another study [3] with 35 patients confirmed that bevacizumab and irinotecan is a very effective treatment for recurrent glioblastoma multiforme and possess a moderate, acceptable toxicity.

Critical Review

However, first appeared in April 2010, a somewhat critical review of the treatment of Gliobastoma multiforme with bevacizumab [4]. Accordingly, bevacizumab is without question multiforme a useful treatment for glioblastoma, but despite the clinical experience and the rapid approval by the FDA, however, remained open many questions. should be given particular questions whether bevacizumab alone or in combination with irinotecan, what dosage you could use or should use, where and when bevacizumab or whether other treatment options should first be addressed. Based on the overall survivor rate, it would do little good use of irinotecan in addition. Irinotecan is also largely responsible for the toxicity of the therapy. Next is recommended instead of other uncontrolled studies carried out, they should now plan well thought-controlled randomized trials and bring to a conclusion.

Study Location

The "United States National Library of Medicine operates its website ClinicalTrials.gov, the largest information database of clinical trials that are currently being planned worldwide and ongoing. This page can be seen that at present a total of 54 studies on Bevazicumab and glioblastoma multiforme are in progress [5,6] - two of them already phase III trials with 920 and 720 patients around the world. This involves the question of whether glioblastoma multiforme, in addition to temozolomide and radiotherapy, even Bevaciumab should be used or not. The studies are expected to continue through 2011 and 2014 respectively.


Sources

[1] Moen MD Bevacizumab in previously treated glioblastoma. Drugs. 2010;70:181-9

[2] Buie LW, Valgus J. Bevacizumab a treatment option for recurrent glioblastoma multiforme
Ann Pharmacother 2008 ;42:1486-90.

[3] Vredenburgh JJ, Desjardins A, Herndon JE 2nd, Marcello J, Reardon DA, Quinn JA, Rich JN, Sathornsumetee S, Gururangan S, Sampson J, Wagner M, Bailey L, Bigner DD, Friedman AH, Friedman HS. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol. 2007; 20;25:4722-9.

[4] Wick W, Weller M, van den Bent M, Stupp R. Bevacizumab and recurrent malignant gliomas: a European perspective. J Clin Oncol. 2009; 1;27:4733-40.

[5] United States National Library of Medicine – Clinicaltrials: bevacizumab glioblastoma | Phase III.http://clinicaltrials.gov/ct2/results?term=bevacizumab+glioblastoma&recr=&rslt=&type=&cond=&intr=&outc=&lead=&spons=&id=&state1=&cntry1=&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&phase=2&rcv_s=&rcv_e=&lup_s=&lup_e=, zugegriffen am17.Juni 2010

[6] United States National Library of Medicine – Clinicaltrials: bevacizumab glioblastom. [link], zugegriffen am17.Juni 2010


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