Anne[a]
neuro-oncology conference in Europe
Bevacizumab (Avastin®) and CPT-11 (Camptosar®) in the Treatment of Relapsed Malignant Glioma
by Dr Viginia Stark Vance about using the combination of the drugs CPT-11 and AVASTIN.
Purpose To evaluate the safety and efficacy of Bevacizumab and CPT-11 in the treatment of patients with relapsed malignant glioma
Patients and Methods:
As of April 30, 2005, 29 patients with relapsed high grade glioma have received at least four consecutive weeks of treatment with Bevacizumab and CPT-11. Patients received Bevacizumab, 5 mg/kg intravenously over 60-90 minutes, every two weeks. Following bevacizumab, and continuing weekly for four weeks, CPT-11 125 mg/m2 was administered intravenously over 90 minutes. One or two week breaks were allowed at the completion of each treatment cycle. Patients were evaluated by MRI at the initiation of treatment and at the completion of the initial four weeks of therapy. Therapy with Bevacizumab was continued at two-week intervals; CPT-11 was held for Grade 3 myelosuppression or Grade 3 non-hematologic toxicity. Treatment continued until disease progression, intolerable toxicity, or patient's decision to discontinue treatment.
Results:
All patients who completed at least four weeks of treatment were considered evaluable for response and toxicity. Toxicities attributed to Bevacizumab included intracranial hemorrhage (1 pt), bowel perforation (1 pt), wound healing abnormalities (2 pts), and epistaxis (5 pts). Toxicities attributed to CPT-11 included myelosuppression (7 pts), nausea and vomiting (4 pts), diarrhea (17 pts) and other cholinergic symptoms (2 pts). Radiographic evidence of response occurred within the first cycle of treatment, with most responses continuing for the duration of therapy. After the initial four-week treatment cycle, three patients had evidence of disease progression and discontinued therapy. Other responses included 3 CR, 16 PR and 7 SD.
As of April 30, 11 patients are alive with continuing response to therapy; 2 pts discontinued CPT-11 because of toxicity but continue to respond to other therapy; and 7 patients are alive with evidence of disease progression. Five patients have died of progressive disease; and 4 patients have died of other complications.
Conclusion;
Bevacizumab and CPT-11 combination therapy demonstrates rapid clinical and radiographic improvement in patients with relapsed malignant glioma, with some patients achieving long term improvement.