OncoLog, Volume 57, Number 10, October 2012 Page: 3
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but this strategy threatens the brain by
causing a leak in the blood-brain barri-
er. Bevacizumab turns off this cytokine
loop and reduces plasma leakage across
brain capillaries, thus reducing brain
MD Anderson researchers presented
at the Society for Neuro-Oncology
conference in November 2011 on the
ability of diffusion-weighted MRI to
predict which patients are most likely
to benefit from bevacizumab treatment.
Although some researchers have
claimed that a larger study is needed
to validate bevacizumab as a standard
treatment for CNS necrosis, Dr. Levin
asserts that the success of each treat-
ment outside of a research study adds
to the growing evidence of its efficacy.
He currently treats primary brain tumor
patients as part of the Kaiser Medical
Group in California and continues to
prescribe bevacizumab, both pre-emp-
tively to minimize radiation damage
and after treatment to reverse radiation
While research for treatments con-
tinues, advances in radiation therapy
may reduce the incidence and severity
of CNS necrosis and other side effects
by minimizing radiation damage to
healthy tissue. Dr. Levin said that pro-
ton therapy may prove to be such an
advance because radiologists can calcu-
late the trajectory of the proton to pin-
point the release of energy to occur
precisely when the proton reaches the
tumor cell, minimizing damage to the
surrounding healthy tissue. Although
this new technique also has caused
instances of radiation necrosis, Dr.
Levin is hopeful that it will lead to
fewer cases of radiation necrosis com-
pared with other treatment modalities.
These exciting developments in radi-
ation therapy and treatment options for
CNS radiation necrosis offer hope for
CNS cancer patients and survivors.
FOR MORE INFORMATION
Dr. Ashok Kumar ..................713-792-3817
Giglio P, Gilbert MR. Cerebral radiation
necrosis. Neurologist 2003;9:180-188.
Kumar AJ, Leeds NE, Fuller GN, et al.
Malignant gliomas: MR imaging
spectrum of radiation therapy- and
chemotherapy-induced necrosis of
the brain after treatment. Radiology
Levin VA, Bidaut L, Hou P, et al.
Randomized double-blind placebo-
controlled trial of bevacizumab therapy
for radiation necrosis of the central
nervous system. Int J Radiat Oncol
Biol Phys 2011;79:1487-1495.
Wu J, Levin VA. Role of Avastin for
treatment of central nervous system
radiation necrosis. In: Chen TC, ed.
Controversies in Neuro-Oncology.
Vol 1. Sharjah, United Arab Emirates:
Bevacizumab With High-Dose Chemotherapy Shows
Promise for Cisplatin-Refractory Germ Cell Tumors
Bevacizumab given concurrently
with high-dose chemotherapy elicits
encouraging results in patients with
treatment-refractory germ cell tumors,
according to the preliminary results of
an ongoing phase II study.
Although high-dose chemotherapy
alone is curative for many patients with
recurrent germ cell tumors, a low rate
of event-free survival is seen in patients
with recurrent disease whose tumors
have developed cisplatin resistance or
who present with high levels of tumor
markers at the time of relapse.
The purpose of the study was to
determine whether the addition of the
antiangiogenic drug bevacizumab to
high-dose chemotherapy helps control
germ cell tumors. Bevacizumab inhibits
vascular endothelial growth factor, a
protein that is highly expressed in
metastatic germ cell tumors. Bevaci-
zumab also increases drug penetration
The 23 patients enrolled so far in
the study have undergone a median of
4 prior chemotherapy regimens (range,
2-6 regimens). Sixteen of the patients
have undergone prior surgery to remove
metastases. The patients received beva-
cizumab (5 mg/kg) 1 week before each
of 2 cycles of high-dose chemotherapy
with stem cell support. The first chemo-
therapy cycle consisted of a novel regi-
men of gemcitabine with docetaxel,
melphalan, and carboplatin; the second
cycle consisted of ifosfamide, carbo-
platin, and etoposide. Patients received
an autologous stem cell infusion after
The most prominent side effect of
the first cycle of high-dose chemotherapy
was mucositis, which resolved. Three
patients died of infections unrelated to
their tumors following the first cycle of
Of the remaining 18 patients, 15
received the second cycle of high-dose
chemotherapy at a median of 49 days
(range, 38-66 days) after their first
stem cell infusion. All patients tolerat-
ed the second chemotherapy cycle well.
Residual lesions were resected in 8 pa-
tients, with biopsy findings of necrosis
or mature teratoma in all cases. At a
median follow-up time of 25 months,
the event-free survival rate was 68%.
Researchers from The University
of Texas MD Anderson Cancer Center
presented the study's preliminary results
in an abstract at the annual meeting
of the American Society of Clinical
Oncology in June.
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University of Texas M.D. Anderson Cancer Center. OncoLog, Volume 57, Number 10, October 2012, periodical, October 2012; Houston, Texas. (texashistory.unt.edu/ark:/67531/metapth639634/m1/3/: accessed October 22, 2018), University of North Texas Libraries, The Portal to Texas History, texashistory.unt.edu; crediting UNT Libraries Government Documents Department.