TY - JOUR
T1 - Bevacizumab for stereotactic radiosurgery-induced radiation necrosis in patients with non-small cell lung cancer treated with immune check-point inhibitors
AU - Moore, Assaf
AU - Yust-Katz, Shlomit
AU - Icht, Oded
AU - Eliyahou, Ruth
AU - Gordon, Noa
AU - Cohen, Aharon Yehonatan
AU - Goldstein, Iris Magdalena
AU - Peled, Nir
AU - Seigal, Tali
AU - Amiel, Alexandra
AU - Dudnik, Elizabeth
N1 - Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/8/15
Y1 - 2021/8/15
N2 - Background: Bevacizumab was shown to be effective in the treatment of brain radiation necrosis (RN) attributed to the use of stereotactic radiosurgery (SRS). Data on its efficacy and safety in non-small cell lung cancer (NSCLC) patients treated with immune check-point inhibitors (ICI) is lacking. Methods: A multi-center retrospective analysis of all consecutive patients with NSCLC treated with ICI, who received bevacizumab for post-SRS RN between April 2017 and June 2020. Improvement in RN-associated symptoms, RN radiological improvement, and decrease in corticosteroid dose following bevacizumab initiation were assessed. Results: Thirteen patients were identified. The median time from diagnosis of RN to initiation of bevacizumab was 3 months (range 1.1–7.8 months), and the median number of bevacizumab cycles before assessment was 2 (range, 1–5). Patients continued ICI during treatment with bevacizumab. Improvement in RN-associated symptoms was observed in 11 patients (85%). In ten patients (77%) the daily dose of dexamethasone was decreased. Radiological improvement of RN occurred in all 11 cases available for radiological assessment (100%). Treatment was withheld in two patients for grade 3–4 toxicity. At a median follow up of 11.9 months (range 2.0–35.4 months), one patient experienced a recurrent episode of RN; the estimated median survival since RN diagnosis was 21.9 months (95% CI 3.8–40.2 months). Conclusion: Treatment with bevacizumab appears to be safe and effective for the treatment of SRS-induced RN in patients with NSCLC treated with ICI. This is the first series to report on the use of bevacizumab in this clinical scenario.
AB - Background: Bevacizumab was shown to be effective in the treatment of brain radiation necrosis (RN) attributed to the use of stereotactic radiosurgery (SRS). Data on its efficacy and safety in non-small cell lung cancer (NSCLC) patients treated with immune check-point inhibitors (ICI) is lacking. Methods: A multi-center retrospective analysis of all consecutive patients with NSCLC treated with ICI, who received bevacizumab for post-SRS RN between April 2017 and June 2020. Improvement in RN-associated symptoms, RN radiological improvement, and decrease in corticosteroid dose following bevacizumab initiation were assessed. Results: Thirteen patients were identified. The median time from diagnosis of RN to initiation of bevacizumab was 3 months (range 1.1–7.8 months), and the median number of bevacizumab cycles before assessment was 2 (range, 1–5). Patients continued ICI during treatment with bevacizumab. Improvement in RN-associated symptoms was observed in 11 patients (85%). In ten patients (77%) the daily dose of dexamethasone was decreased. Radiological improvement of RN occurred in all 11 cases available for radiological assessment (100%). Treatment was withheld in two patients for grade 3–4 toxicity. At a median follow up of 11.9 months (range 2.0–35.4 months), one patient experienced a recurrent episode of RN; the estimated median survival since RN diagnosis was 21.9 months (95% CI 3.8–40.2 months). Conclusion: Treatment with bevacizumab appears to be safe and effective for the treatment of SRS-induced RN in patients with NSCLC treated with ICI. This is the first series to report on the use of bevacizumab in this clinical scenario.
KW - Bevacizumab
KW - Immune check-point inhibitors
KW - Immunotherapy
KW - Non-small cell lung cancer
KW - Radiation necrosis
KW - Stereotactic radiosurgery
UR - http://www.scopus.com/inward/record.url?scp=85109584146&partnerID=8YFLogxK
U2 - 10.1016/j.jns.2021.117556
DO - 10.1016/j.jns.2021.117556
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C2 - 34186494
AN - SCOPUS:85109584146
SN - 0022-510X
VL - 427
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 117556
ER -