Bevacizumab and gefitinib enhanced whole-brain radiation therapy for brain metastases due to non-small-cell lung cancer

Rui, Yang; Yu, Bu Chin; Zhang, R.Q.; Wang, X.H.; Li, C.; Wang, P.; Zhang, Y.; Han, Baohui; Gao, Xue; Zhang, L.; Jiang, Zhe

doi:10.1590/1414-431x20176073

Cited by 16 publications

(10 citation statements)

References 40 publications

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“…Other nonrandomized Six studies [70][71][72][73][74][75] 51 studies [76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99] 18 studies [127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143][144] Three studies [145][146][147] Abbreviation: RCTs, randomized controlled trials.…”

Section: Summary Of Key Trials Published Prior To 2008mentioning

confidence: 99%

Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

Vogelbaum

Brown

Messersmith

et al. 2022

JCO

419

222

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PURPOSE To provide guidance to clinicians regarding therapy for patients with brain metastases from solid tumors. METHODS ASCO convened an Expert Panel and conducted a systematic review of the literature. RESULTS Thirty-two randomized trials published in 2008 or later met eligibility criteria and form the primary evidentiary base. RECOMMENDATIONS Surgery is a reasonable option for patients with brain metastases. Patients with large tumors with mass effect are more likely to benefit than those with multiple brain metastases and/or uncontrolled systemic disease. Patients with symptomatic brain metastases should receive local therapy regardless of the systemic therapy used. For patients with asymptomatic brain metastases, local therapy should not be deferred unless deferral is specifically recommended in this guideline. The decision to defer local therapy should be based on a multidisciplinary discussion of the potential benefits and harms that the patient may experience. Several regimens were recommended for non–small-cell lung cancer, breast cancer, and melanoma. For patients with asymptomatic brain metastases and no systemic therapy options, stereotactic radiosurgery (SRS) alone should be offered to patients with one to four unresected brain metastases, excluding small-cell lung carcinoma. SRS alone to the surgical cavity should be offered to patients with one to two resected brain metastases. SRS, whole brain radiation therapy, or their combination are reasonable options for other patients. Memantine and hippocampal avoidance should be offered to patients who receive whole brain radiation therapy and have no hippocampal lesions and 4 months or more expected survival. Patients with asymptomatic brain metastases with either Karnofsky Performance Status ≤ 50 or Karnofsky Performance Status < 70 with no systemic therapy options do not derive benefit from radiation therapy. Additional information is available at www.asco.org/neurooncology-guidelines .

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Section: Summary Of Key Trials Published Prior To 2008mentioning

confidence: 99%

Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

Vogelbaum

Brown

Messersmith

et al. 2022

JCO

419

222

View full text Add to dashboard Cite

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“…Across WBRT studies, most adverse events were seen in the combination of WBRT plus radiosensitizer compared with WBRT alone (2,255 vs 1,009 events) 9,10,13,41,42 and WBRT plus systemic therapy (1,570 vs 1,150). [43][44][45][46][47][48][49][50][51][52][53][54] The number of events was similar for WBRT as adjunctive therapy (211 vs 204), 55,56 WBRT plus SRS versus WBRT alone (174 vs 160), 3,4 and WBRT plus surgery versus WBRT alone (11 vs 8). 6 SRS studies showed some differences for SRS plus WBRT versus SRS alone (182 vs 145) [27][28][29] ; SRS plus WBRT versus WBRT (171 vs 157) 3 ; and the combination of SRS plus WBRT…”

Section: Adverse Events In Wbrt and Srs Studiesmentioning

confidence: 99%

Radiation Therapy for Brain Metastases: A Systematic Review

Garsa

Jang

Baxi

et al. 2021

Practical Radiation Oncology

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This evidence report synthesizes the available evidence on radiation therapy for brain metastases. Methods and Materials: The literature search included PubMed, EMBASE, Web of Science, Scopus, CINAHL, clinicaltrials.gov, and published guidelines in July 2020; independently submitted data, expert consultation, and contacting authors. Included studies were randomized controlled trials (RCTs) and large observational studies (for safety assessments), evaluating whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination, as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to lung cancer, breast cancer, or melanoma. Results: Ninety-seven studies reported in 189 publications were identified, but the number of analyses was limited owing to different intervention and comparator combinations as well as insufficient reporting of outcome data. Risk of bias varied, and 25 trials were terminated early, predominantly owing to poor accrual. The combination of SRS plus WBRT compared with SRS alone or WBRT alone showed no statistically significant difference in overall survival (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.69%-1.73%; 4 RCTs) or death owing to brain metastases (relative risk [RR], 0.93; 95% CI, 0.48%-1.81%; 3 RCTs). Radiation therapy after surgery did not improve overall survival compared with surgery alone (HR, 0.98; 95% CI, 0.76%-1.26%; 5 RCTs). Data for quality of life, functional status, and cognitive effects were insufficient to determine effects of WBRT, SRS, or postsurgery interventions. We did not find systematic differences across interventions in serious adverse events, number of adverse events, radiation necrosis, fatigue, or seizures. WBRT plus systemic therapy (RR 1.44; 95% CI, 1.03%-2.00%; 14 studies) was associated with increased risks for vomiting compared with WBRT alone. Conclusions: Despite the substantial research literature on radiation therapy, comparative effectiveness information is limited. There is a need for more data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.

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“…Seventeen studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] were selected based on the eligibility criteria (Figure 1). Fifteen studies had 7,212 NSCLC patients with BM at baseline, of which 1,548 were treated with BEV in combination with one or more therapies including chemotherapy, radiotherapy, stereotactic radiosurgery, and TKIs, and 5,664 patients served as controls who were treated with one or more of the above-mentioned therapies without BEV.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Bevacizumab for non-small cell lung cancer patients with brain metastasis: A meta-analysis

et al. 2020

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AbstractThis study evaluates the efficacy and safety of bevacizumab (BEV) in the treatment of non-small cell lung cancer (NSCLC) patients with brain metastases (BM) by performing meta-analyses of response and survival indices. Seventeen studies were included. BEV treatment was associated with a lower new BM incidence (hazard ratio: 0.30 [95% confidence interval (CI): 0.14, 0.46]) during follow-up. Disease control rate (DCR) of BEV-treated patients with BM was 91% [95% CI: 85, 95]. However, intracranial DCR was relatively higher (94% [95% CI: 87, 98]) than extracranial DCR (86% [95% CI: 74, 96]). DCR of NSCLC patients with BM was significantly better with BEV than with control therapies (odds ratio: 2.71 [95% CI: 1.26, 5.86], P = 0.01). Progression-free survival (PFS) of BEV-treated patients with and without BM was 7.1 months [95% CI: 6.2, 8.0] and 7.4 months [95% CI: 6.3, 8.4], respectively. Intracranial PFS of BEV-treated patients with BM was 8.0 months [95% CI: 6.0, 10.0]. Overall survival of BEV-treated NSCLC patients with and without BM was 13.5 months [95% CI: 11.4, 15.6] and 12.5 months [95% CI: 10.2, 14.8], respectively. The incidence of bleeding/hemorrhage in the central nervous system was 1% with BEV treatment.

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Bevacizumab and gefitinib enhanced whole-brain radiation therapy for brain metastases due to non-small-cell lung cancer

Cited by 16 publications

References 40 publications

Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline

Radiation Therapy for Brain Metastases: A Systematic Review

Bevacizumab for non-small cell lung cancer patients with brain metastasis: A meta-analysis

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