January 17, 2014
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Bevacizumab, irinotecan combination effective in children with recurrent, low-grade glioma

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Bevacizumab plus irinotecan stabilized disease progression in a cohort of children with progressive, low-grade glioma, according to results of a phase 2 study.

“Bevacizumab either alone or in combination can be used as one of the therapeutic approaches for children with recurrent low-grade glioma and may help to defer or avoid radiotherapy, especially in young children,” Sridharan Gururangan, MRCP, professor of pediatrics, associate professor of surgery and director of pediatric clinical services at The Preston Robert Tisch Brain Tumor Center at Duke University Medical Center, told HemOnc Today. “This treatment regimen appears to be reasonably well tolerated as well in these children, although the impact of bevacizumab on linear growth — especially in young children — is unknown.”

Gururangan and colleagues set out to assess the use of bevacizumab (Avastin, Genentech) plus irinotecan (Camptosar, Pfizer) on PFS, as well as sustained response and/or stable disease, in 35 children (median age, 8.4 years; range, 0.6-17.6) with recurrent, low-grade glioma.

Patients received two doses of 10 mg/kg bevacizumab via IV 2 weeks apart, followed by bevacizumab plus irinotecan every 2 weeks until disease progression, unacceptable toxicity or a maximum of 2 years of therapy.

Patients received a median of 12 courses of bevacizumab plus irinotecan; 29 patients (83%) were treated for at least 6 months.

PFS was 85.4% at 6 months and 47.8% at 2 years.

Eight patients progressed on treatment. Median time to progression was 5.4 months (range, 1-17.8).

At the time of analysis, six patients (17.7%) still in follow-up continued to have stable disease without additional treatment. Among those patients, median time since treatment duration was 40.1 months (range, 30.6-49.3).

Common grade 1 and grade 2 adverse events were hypertension (68.5%), fatigue (65.7%) and epistaxis (51.4%). Researchers observed significant decreases in median volume of enhancement between baseline and day 15 (P<.0001), as well as during the duration of treatment (P<.037).

“Further research is required on whether bevacizumab can be combined with other targeted therapies for children with low-grade glioma,” Gururangan said. “Biomarkers that might predict for response to this agent need to be explored.”

Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.