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Chaban A, Waschulzik B, Bernhardt D, Delbridge C, Schmidt-Graf F, Wagner A, Wiestler B, Weber W, Yakushev I. Amino acid PET vs. RANO MRI for prediction of overall survival in patients with recurrent high grade glioma under bevacizumab therapy. Eur J Nucl Med Mol Imaging 2024; 51:1698-1702. [PMID: 38228970 PMCID: PMC11043199 DOI: 10.1007/s00259-024-06601-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/01/2024] [Indexed: 01/18/2024]
Abstract
PURPOSE To summarize evidence on the comparative value of amino acid (AA) PET and conventional MRI for prediction of overall survival (OS) in patients with recurrent high grade glioma (rHGG) under bevacizumab therapy. METHODS Medical databases were screened for studies with individual data on OS, follow-up MRI, and PET findings in the same patient. MRI images were assessed according to the RANO criteria. A receiver operating characteristic curve analysis was used to predict OS at 9 months. RESULTS Five studies with a total of 72 patients were included. Median OS was significantly lower in the PET-positive than in the PET-negative group. PET findings predicted OS with a pooled sensitivity and specificity of 76% and 71%, respectively. Corresponding values for MRI were 32% and 82%. Area under the curve and sensitivity were significantly higher for PET than for MRI. CONCLUSION For monitoring of patients with rHGG under bevacizumab therapy, AA-PET should be preferred over RANO MRI.
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Affiliation(s)
- Artem Chaban
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Birgit Waschulzik
- Institute of AI and Informatics in Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Denise Bernhardt
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiation Oncology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claire Delbridge
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Pathology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Friederike Schmidt-Graf
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Arthur Wagner
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
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Sun M, Baker TL, Wilson CT, Brady RD, Yamakawa GR, Wright DK, Mychasiuk R, Vo A, Wilson T, Allen J, McDonald SJ, Shultz SR. Treatment with the vascular endothelial growth factor-A antibody, bevacizumab, has sex-specific effects in a rat model of mild traumatic brain injury. J Cereb Blood Flow Metab 2024; 44:542-555. [PMID: 37933736 PMCID: PMC10981407 DOI: 10.1177/0271678x231212377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
Mild traumatic brain injury (mTBI) involves damage to the cerebrovascular system. Vascular endothelial growth factor-A (VEGF-A) is an important modulator of vascular health and VEGF-A promotes the brain's ability to recover after more severe forms of brain injury; however, the role of VEGF-A in mTBI remains poorly understood. Bevacizumab (BEV) is a monoclonal antibody that binds to VEGF-A and neutralises its actions. To better understand the role of VEGF-A in mTBI recovery, this study examined how BEV treatment affected outcomes in rats given a mTBI. Adult Sprague-Dawley rats were assigned to sham-injury + vehicle treatment (VEH), sham-injury + BEV treatment, mTBI + VEH treatment, mTBI + BEV treatment groups. Treatment was administered intracerebroventricularly via a cannula beginning at the time of injury and continuing until the end of the study. Rats underwent behavioral testing after injury and were euthanized on day 11. In both females and males, BEV had a negative impact on cognitive function. mTBI and BEV treatment increased the expression of inflammatory markers in females. In males, BEV treatment altered markers related to hypoxia and vascular health. These novel findings of sex-specific responses to BEV and mTBI provide important insights into the role of VEGF-A in mTBI.
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Affiliation(s)
- Mujun Sun
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tamara L Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Campbell T Wilson
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rhys D Brady
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Glenn R Yamakawa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anh Vo
- Monash Health Translation Precinct, Monash University, Melbourne, VIC, Australia
| | - Trevor Wilson
- Monash Health Translation Precinct, Monash University, Melbourne, VIC, Australia
| | - Josh Allen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Health Sciences, Vancouver Island University, Nanaimo, BC, Canada
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Vakilian S, Al-Hashmi S, Al-Kindi J, Al-Fahdi F, Al-Wahaibi N, Shalaby A, Al-Riyami H, Al-Harrasi A, Jamshidi-Adegani F. Avastin-loaded 3D-printed Alginate Scaffold as an Effective Anti-Adhesive Barrier to Prevent Post-Surgical Adhesion Bands Formation. Macromol Biosci 2024:e2300530. [PMID: 38319279 DOI: 10.1002/mabi.202300530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/18/2024] [Indexed: 02/07/2024]
Abstract
Post-operative adhesion can cause complications, such as pain, and organ blockage, in the abdominal regions. To address this issue, surgical techniques, and anti-adhesive treatments have been applied. Given the significant role of vascularization in adhesion band formation, Avastin (Ava) that targets VEGF can be applied to prevent peritoneal adhesion bands. Moreover, Alginate (Alg), a natural polysaccharide, is a promising physical barrier to prevent adhesion bands. Incorporating Ava into Alg hydrogel in a form of 3D-printed scaffold (Alg/Ava) has potential to suppress inflammation and angiogenesis, leading to reduce peritoneal adhesion bands. Following physical, morphological, and biocompatibility evaluations, the efficacy of Alg and Ava alone and their combination in Alg/Ava on the formation of post-surgical adhesions was evaluated. Upon confirming physical stability and sustained release of Ava, the Alg/Ava scaffold effectively diminished both the extent and strength of adhesion bands. Histopathological examination showed that the reduction in fibrosis and inflammation was responsible for preventing adhesion bands by the Alg/Ava scaffold. Additionally, the cytokine assessment revealed that this was due to the inhibition in the secretion of VEGF and IL-6, suppressing vascularization and inflammatory pathways. This study suggests that a 3D-printed Alg/Ava scaffold has great potential to prevent the post-surgical adhesion bands. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Saeid Vakilian
- Laboratory for Stem Cell & Regenerative Medicine, Natural and Medical Sciences Research Center, University of Nizwa, P. O. Box: 33, Nizwa, PC 616, Oman
| | - Sulaiman Al-Hashmi
- Laboratory for Stem Cell & Regenerative Medicine, Natural and Medical Sciences Research Center, University of Nizwa, P. O. Box: 33, Nizwa, PC 616, Oman
| | - Juhaina Al-Kindi
- Laboratory for Stem Cell & Regenerative Medicine, Natural and Medical Sciences Research Center, University of Nizwa, P. O. Box: 33, Nizwa, PC 616, Oman
| | - Fahad Al-Fahdi
- Laboratory for Stem Cell & Regenerative Medicine, Natural and Medical Sciences Research Center, University of Nizwa, P. O. Box: 33, Nizwa, PC 616, Oman
| | - Nasar Al-Wahaibi
- Department of Biomedical Science, College of Medicine & Health Sciences, Sultan Qaboos University, P. O. Box: 35, Alkoudh, 123, Oman
- Department of Pathology, College of Medicine & Health Sciences, Sultan Qaboos University, P. O. Box: 35, Alkoudh, 123, Oman
| | - Asem Shalaby
- Department of Pathology, College of Medicine & Health Sciences, Sultan Qaboos University, P. O. Box: 35, Alkoudh, 123, Oman
- Pathology department, College of Medicine, Mansoura University, Egypt
| | - Hamad Al-Riyami
- Department of Genetics, College of Medicine and Health Sciences, Sultan Qaboos University, P. O. Box: 35, Alkoudh, PC 123, Oman
| | - Ahmed Al-Harrasi
- Laboratory for Stem Cell & Regenerative Medicine, Natural and Medical Sciences Research Center, University of Nizwa, P. O. Box: 33, Nizwa, PC 616, Oman
| | - Fatemeh Jamshidi-Adegani
- Laboratory for Stem Cell & Regenerative Medicine, Natural and Medical Sciences Research Center, University of Nizwa, P. O. Box: 33, Nizwa, PC 616, Oman
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Dyck YFK, Rehm D, Winkler K, Sandig V, Jabs W, Parr MK. Comparison of middle- and bottom-up mass spectrometry in forced degradation studies of bevacizumab and infliximab. J Pharm Biomed Anal 2023; 235:115596. [PMID: 37540995 DOI: 10.1016/j.jpba.2023.115596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023]
Abstract
Monoclonal antibodies (mAbs) used as therapeutics need comprehensive characterization for appropriate quality assurance. For analysis, cost-effective methods are of high importance, especially when it comes to biosimilar development which is based on extended physicochemical characterization. The use of forced degradation to study the occurrence of modifications for analysis is well established in drug development and may be used for the evaluation of critical quality attributes (CQAs). For mAb analysis different procedures of liquid chromatography hyphenated with mass spectrometry (LC-MS) analyses are commonly applied. In this study the middle-up approach is compared to the more expensive bottom-up analysis in a forced oxidation biosimilar comparability study. Bevacizumab and infliximab as well as biosimilar candidates for the two mAbs were forcefully oxidized by H2O2 for 24, 48 and 72 h. For bottom-up, the reduced and alkylated trypsin or Lys-C digested samples were analysed by LC-MS with quadrupole time-of-flight mass analyser (LC-QTOF-MS) to detect susceptible residues. By middle-up analysis several species of every subunit (Fc/2, light chain and Fd') were detected which differed in the number of oxidations. For the most abundant species, results from middle-up were in line with results from bottom-up analysis, confirming the strength of middle-up analysis. However, for less abundant species of some subunits, results differed between the two approaches. In both mAbs, the Fc was extensively oxidized. In infliximab, additional extensive oxidation was found in the Fab. Assignment to specific amino acid residues was finally possible using the results from bottom-up analyses. Interestingly, the C-terminal cysteine of the light chain was partially found triply oxidized in both mAbs. The comparison of susceptibility to oxidation showed high similarity between the reference products and their biosimilar candidates. It is suggested that the findings of middle-up experiments should be complemented by bottom-up analysis to confirm the assignments of the localization of modifications. Once the consistency of results has been established, middle-up analyses are sufficient in extended forced degradation biosimilar studies.
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Affiliation(s)
- Yan Felix Karl Dyck
- Department of Pharmaceutical & Medicinal Chemistry, Institute of Pharmacy, Freie Universität Berlin, Königin-Luise-Straße 2+4, 14195 Berlin, Germany; Department of Life Sciences & Technology, Berlin University of Applied Science, Seestraße 64, 13347 Berlin, Germany
| | - Daniel Rehm
- Department of Pharmaceutical & Medicinal Chemistry, Institute of Pharmacy, Freie Universität Berlin, Königin-Luise-Straße 2+4, 14195 Berlin, Germany; ProBioGen AG, Herbert-Bayer-Straße 8, 13086 Berlin, Germany
| | | | - Volker Sandig
- ProBioGen AG, Herbert-Bayer-Straße 8, 13086 Berlin, Germany
| | - Wolfgang Jabs
- Department of Life Sciences & Technology, Berlin University of Applied Science, Seestraße 64, 13347 Berlin, Germany
| | - Maria Kristina Parr
- Department of Pharmaceutical & Medicinal Chemistry, Institute of Pharmacy, Freie Universität Berlin, Königin-Luise-Straße 2+4, 14195 Berlin, Germany.
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Tatebayashi K, Nakayama N, Sakamoto D, Iida T, Ono S, Matsuda I, Enomoto Y, Tanaka M, Fujita M, Hirota S, Yoshimura S. Clinical Significance of Early Venous Filling Detected via Preoperative Angiography in Glioblastoma. Cancers (Basel) 2023; 15:3800. [PMID: 37568616 PMCID: PMC10416945 DOI: 10.3390/cancers15153800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Preoperative angiography in glioblastoma (GBM) often shows arteriovenous shunts and early venous filling (EVF). Here, we investigated the clinical implications of EVF in GBM as a prognostic and vascular mimicry biomarker. In this retrospective multicenter study, we consecutively enrolled patients who underwent angiography with a GBM diagnosis between 1 April 2013 and 31 March 2021. The primary and secondary endpoints were the differences in overall survival (OS) and progression-free survival (PFS), respectively, between cases with and without EVF. Of the 133 initially enrolled patients, 91 newly diagnosed with GBM underwent preoperative angiography and became the study population. The 6-year OS and PFS were significantly worse in the EVF than in the non-EVF group. Moreover, 20 GBM cases (10 with EVF and 10 without EVF) were randomly selected and evaluated for histological vascular mimicry. Except for two cases that were difficult to evaluate, the EVF group had a significantly higher frequency of vascular mimicry than the non-EVF group (0/8 vs. 5/10, p = 0.04). EVF on preoperative angiography is a robust prognostic biomarker for GBM and may help detect cases with a high frequency of histological vascular mimicry.
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Affiliation(s)
- Kotaro Tatebayashi
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.T.); (D.S.); (T.I.); (S.O.)
| | - Noriyuki Nakayama
- Department of Neurosurgery, Gifu University, Gifu 501-1112, Japan; (N.N.); (Y.E.)
| | - Daisuke Sakamoto
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.T.); (D.S.); (T.I.); (S.O.)
| | - Tomoko Iida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.T.); (D.S.); (T.I.); (S.O.)
| | - Shun Ono
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.T.); (D.S.); (T.I.); (S.O.)
| | - Ikuo Matsuda
- Department of Surgical Pathology, Hyogo Medical University, Nishinomiya 663-8501, Japan; (I.M.); (S.H.)
| | - Yukiko Enomoto
- Department of Neurosurgery, Gifu University, Gifu 501-1112, Japan; (N.N.); (Y.E.)
| | - Michihiro Tanaka
- Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa 296-0041, Japan;
| | - Mitsugu Fujita
- Department of Medicine, Graduate School of Medical Sciences, Kindai University, Higashiosaka 577-8502, Japan;
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo Medical University, Nishinomiya 663-8501, Japan; (I.M.); (S.H.)
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.T.); (D.S.); (T.I.); (S.O.)
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Hertzberg SNW, Moe MC, Jørstad ØK, Petrovski BÉ, Burger E, Petrovski G. Healthcare expenditure of intravitreal anti-vascular endothelial growth factor inhibitors compared with dexamethasone implant for diabetic macular oedema. Acta Ophthalmol 2022; 100:e1630-e1640. [PMID: 35467793 PMCID: PMC9790387 DOI: 10.1111/aos.15151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to estimate the 1-year costs associated with treating diabetic macular oedema (DME) patients using current intravitreal anti-vascular endothelial growth factor (anti-VEGF) biologics compared with the dexamethasone implant. METHODS We conducted a descriptive cost-evaluation analysis using data from Oslo University Hospital and literature to compare three different intravitreal drugs for DME: bevacizumab, aflibercept and dexamethasone. Stratification of patients into 'Naive' or 'Switch' group was based on treatment history. We estimated the costs from healthcare and 'extended' healthcare perspectives. Sensitivity analysis evaluated the impact of various parameters. RESULTS The average injections per patient per year for the Naive group (bevacizumab), Switch group (aflibercept) and dexamethasone were 9.5, 9.1 and 3.0 respectively. From a healthcare perspective, the 1-year costs for the Naive group were 15% lower (bevacizumab, €3619), and for the Switch group, 23% higher (aflibercept, €5226) compared with dexamethasone (€4252). The 'extended' healthcare perspective showed the cost per patient per year for bevacizumab remained nominally lower in the Naive group, while dexamethasone remained lower for the Switch group (€5116 for dexamethasone, compared to €4987 for bevacizumab and €6537 for aflibercept). CONCLUSIONS From a primary healthcare perspective, the dexamethasone as a first-line DME treatment may increase economic costs in settings where bevacizumab is used off-label. Treating resistant DMEwith dexamethasone may reduce the costs and treatment burden compared with switching to aflibercept.
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Affiliation(s)
- Silvia NW Hertzberg
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
| | - Morten Carstens Moe
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
| | - Beáta Éva Petrovski
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
| | - Emily Burger
- Department of Health Management and Health EconomicsUniversity of OsloOsloNorway,Center for Health Decision ScienceHarvard T. H. Chan School of Public HealthBostonMAUSA
| | - Goran Petrovski
- Department of Ophthalmology, Faculty of Medicine, Center for Eye Research, Oslo University Hospital and Institute for Clinical MedicineUniversity of OsloOsloNorway
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Taheri SL, Rezazadeh M, Hassanzadeh F, Akbari V, Dehghani A, Talebi A, Mostafavi SA. Preparation, physicochemical, and retinal anti-angiogenic evaluation of poloxamer hydrogel containing dexamethasone/ avastin-loaded chitosan-N-acetyl-L-cysteine nanoparticles. Int J Biol Macromol 2022; 220:1605-1618. [PMID: 36116595 DOI: 10.1016/j.ijbiomac.2022.09.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022]
Abstract
This study was meant to describe a Poloxamer hydrogel combining Chitosan-N-acetyl-L-cysteine (CNAC) nanoparticles to increase loading and sustained intravitreal administration of Avastin macromolecule. To increase the drug's efficacy and reduce the interfacial fluid pressure in a formulation, dexamethasone was used. To do so, CNAC was synthesized. Then, Avastin- loaded CNAC nanoparticles were prepared and optimized. The resulting hydrogel's sol-gel transition time and viscosity were determined using poloxamer and hydroxypropylmethylcellulose (HPMC). In vitro and in vivo investigations of Avastin-loaded CNAC nanoparticles and hydrogel comprising dexamethasone/Avastin-loaded CNAC nanoparticles were determined. In vitro, the drug release profile of optimized hydrogel containing Avastin-loaded CNAC nanoparticles was sustained and controlled over 256 h. The obtained results point to poloxamer/HPMC (18 %/0.5 %) as the best formulations for this hydrogel to develop a sol-gel transition. About 97 % of dexamethasone was released from the hydrogel within 18 h. In vivo results indicated that the optimized formulation compared with free Avastin could improve Diabetic retinopathy (DR). Consequently, we infer that this new drug delivery method may enhance Avastin intravitreal administration, lowering the frequency, danger, and expense of heavy intravitreal injections and resulting in improved treatment of posterior eye segment neovascularization and concomitant vitreoretinal disorders.
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Affiliation(s)
- Sayed Latif Taheri
- Department of Pharmaceutics, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboubeh Rezazadeh
- Department of Pharmaceutics, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farshid Hassanzadeh
- Department of Medicinal Chemistry, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vajihe Akbari
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Dehghani
- Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ardeshir Talebi
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Abolfazl Mostafavi
- Department of Pharmaceutics, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.
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Yang L, Liu M, Cao X, Li N, Zheng B, Deng J, Cai H. Efficacy and safety of adding bevacizumab biosimilar or original drug to platinum-based chemotherapy as first-line treatment in patients with advanced NSCLC: a systematic review and meta-analysis. Ther Adv Med Oncol 2022; 14:17588359221130501. [PMID: 36312816 PMCID: PMC9597053 DOI: 10.1177/17588359221130501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The role of bevacizumab combined with paclitaxel and carboplatin in the first-line treatment of advanced non-squamous non-small-cell lung cancer (NSCLC) has been supported by a large number of data. However, whether bevacizumab biosimilars have the same efficacy and safety as the original drug is still controversial. This meta-analysis was designed to evaluate whether bevacizumab biosimilars have the same clinical efficacy and safety as the original drug in patients with advanced non-squamous NSCLC. Methods Electronic databases (PubMed, Embase, Cochrane, CNKI, Wanfang, and VIP) and the ClinicalTrail.gov website were extensively searched using relevant search criteria. We included phase III randomized controlled trials (RCTs) to compare the efficacy and safety of marketed biosimilars and Avastin in the first-line treatment of patients with advanced NSCLC. The risk of bias of the included studies was assessed using the RoB 2 assessment scale, and the RevMan 5.4 statistical software was used for meta-analysis. Results A total of 6360 patients were included in 11 RCTs. There was no statistical difference between the experimental group and the control group in terms of effectiveness [objective response rate (at week 18), disease control rate (at week 18), median duration of response, median progression-free survival, median overall survival (OS), and OS after 12 months]. In terms of safety [treatment-emergent adverse events (grade ⩾3) and treatment-related adverse events (grade ⩾3)], there was also no significant difference between biosimilars and Avastin. Conclusions The efficacy and safety of bevacizumab biosimilars in the treatment of advanced non-squamous NSCLC are highly similar to those of the original drug combined with paclitaxel and carboplatin, respectively.
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Affiliation(s)
| | | | - Xueqiong Cao
- Fujian Medical University Union Hospital,
Fuzhou, China,Fujian Medical University, Fuzhou, China
| | - Na Li
- Fujian Medical University Union Hospital,
Fuzhou, China,Fujian Medical University, Fuzhou, China
| | - Bin Zheng
- Fujian Medical University Union Hospital,
Fuzhou, China,Fujian Medical University, Fuzhou, China
| | - Jianhao Deng
- The Second Hospital of Longyan, Longyan,
Fujian, China
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9
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A ranibizumab ocular implant (Susvimo) for age-related macular degeneration. Med Lett Drugs Ther 2022; 64:71-2. [PMID: 35471228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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10
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Faricimab (Vabysmo) for age-related macular degeneration and diabetic macular edema. Med Lett Drugs Ther 2022; 64:45-6. [PMID: 35294428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Rizwan A, Asghar A, Sughra U, Yasmin N. Endophthalmitis Postintravitreal Bevacizumab Injections: Incidence, Management, and Visual Outcome in Tertiary Care Center in Pakistan. Oman J Ophthalmol 2022; 15:20-24. [PMID: 35388253 PMCID: PMC8979382 DOI: 10.4103/ojo.ojo_103_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/23/2021] [Accepted: 08/28/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose is to study the incidence, characteristics, management, and visual outcome of endophthalmitis postintravitreal bevacizumab (Avastin®) injections. METHODS Retrospective cohort study conducted at Fauji Foundation Hospital that is a tertiary care center in Rawalpindi, Pakistan. The study duration was from January 1, 2015 to March 31, 2020. A total of 2321 eyes of 1407 patients were treated with Intravitreal bevacizumab (IVB) in a minor operation theater using standard aseptic measures. We studied the incidence, clinical characteristics, treatment, and visual outcomes of endophthalmitis post-IVB. RESULTS Seven eyes (0.30%) out of 2321 eyes developed post-IVB endophthalmitis during the study period. Three eyes (42.8%) were culture positive and four eyes (57.2%) were culture negative. Five eyes (71.4%) showed visual improvement and two eyes (28.6%) did not show visual improvement. CONCLUSION Prompt intravitreal antibiotic along with vitreous tap in cases of postintravitreal endophthalmitis may prevent vision loss which provides a useful alternative to immediate pars plana vitrectomy that requires more expertise, equipment, and an operation theater.
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Affiliation(s)
- Amna Rizwan
- Department of Ophthalmology, KEMU, Lahore, Pakistan,Address for correspondence: Dr. Amna Rizwan, Department of Ophthalmology, KEMU, Lahore, Pakistan. E-mail:
| | - Asfandyar Asghar
- Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Ume Sughra
- Department of Community Medicine, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Naila Yasmin
- Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan
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12
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Ruiz R, Balamuth N, Javia LR, Zur KB. Systemic Bevacizumab Treatment for Recurrent Respiratory Papillomatosis: Long-Term Follow-Up. Laryngoscope 2022; 132:2071-2075. [PMID: 35043981 DOI: 10.1002/lary.30021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Systemic bevacizumab is a new adjuvant therapy for recurrent respiratory papillomatosis (RRP) that has shown promising preliminary results in children. The objective of this study was to report the largest series to date that includes long-term follow-up data on bevacizumab treatment. STUDY DESIGN Retrospective chart review. METHODS Retrospective review of seven pediatric patients treated within the past 6 years with systemic bevacizumab for RRP refractory to traditional debridement. RESULTS All seven patients had a significant reduction in disease burden after initiation of systemic bevacizumab. There have been no major complications associated with systemic therapy so far. Median duration of bevacizumab treatment was 2.13 years. Three of the seven patients have been on treatment for over 3 years with the longest duration of treatment in our first patient now at 5.5 years. One patient experienced significant disease recurrence on two occasions when therapy was temporarily discontinued and was recently diagnosed with squamous cell carcinoma of the lung. CONCLUSION Systemic bevacizumab is an effective therapy for cases of severe RRP with promising results both in short-term and long-term follow-up. Side effects are minimal. Patients must be followed closely to determine appropriate dosing intervals to control disease and to screen for disease progression. LEVEL OF EVIDENCE IV Laryngoscope, 2022.
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Affiliation(s)
- Ryan Ruiz
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Naomi Balamuth
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Luv R Javia
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Karen B Zur
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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13
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Palfi (Salavat) MC, Șeclăman EP, Barac R, Ungureanu E, Iorgu G, Artamonov A, Leuștean L, Borugă MV. The role of Anti-VEGF agents in treatment of neovascular glaucoma. Rom J Ophthalmol 2022; 66:209-213. [PMID: 36349171 PMCID: PMC9585493 DOI: 10.22336/rjo.2022.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 12/03/2022] Open
Abstract
Aim: The aim of this study was to show the efficacy of intravitreal treatment with Bevacizumab (Avastin) in patients with secondary neovascular glaucoma, in different stages of the disease. Method: A retrospective study was performed on 67 patients with neovascular glaucoma. The main parameters evaluated were the patients' history, slit lamp examination, visual acuity, ocular tonometry, fundus examination, gonioscopy, and visual field. Results: It was observed that the pathology had a preponderance in males of the 6th decade, with frequently unilateral damage. Patients were referred to an ophthalmologist when the diseases reached an advanced stage, usually when the visual acuity had no light perception and the intraocular pressure was over 45 mmHg. However, the treatment with Avastin intravitreal showed a good evolution, with regression of neovessels in the first 4-7 days and maintenance of intraocular pressure within normal limits in about 60% of cases, 3 months after injection. Conclusion: The most effective treatment in secondary neovascular glaucoma is the correct therapy of the main disease. The association of Avastin and laser photocoagulation leads to regression in iris and retinal neovessels. Abbreviations: anti-VEGF = anti-Vascular Endothelial Growth Factor, PDGF = Platelet Derived Growth Factor, bFGF = basic Fibroblast Growth Factor.
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Affiliation(s)
| | - Edward Paul Șeclăman
- Department of Biochemistry, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
| | - Ramona Barac
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Emil Ungureanu
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | - Mădălina Veronica Borugă
- Department of Toxicology and Drug Industry, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
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14
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Bouquet de Joliniere J, Fruscalzo A, Khomsi F, Stochino Loi E, Cherbanyk F, Ayoubi JM, Feki A. Antiangiogenic Therapy as a New Strategy in the Treatment of Endometriosis? The First Case Report. Front Surg 2021; 8:791686. [PMID: 34938768 PMCID: PMC8685206 DOI: 10.3389/fsurg.2021.791686] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Angiogenesis plays a pivotal role in implantation and development of ectopic endometrial lesions. Thus, the potential usefulness of anti-angiogenic therapies has been speculated. Several reports describe their usefulness in animal models. Nonetheless this therapy has not been tested on humans yet. Here we report the outcome of a patient treated for a severe endometriosis with Bevacizumab (Avastin®), a monoclonal antibody directed against the vascular endothelial growth (VEGF). After a first-look laparoscopy with confirmatory biopsies was performed, three doses of Bevacizumab at 2-week intervals were administered. The therapy showed a well-tolerated profile and the prompt disappearance of the therapy-refractory chronic dysmenorrhea. A suppression of metabolic activity at the PET-scan compared to the basal one performed at diagnosis was also recorded. Furthermore, compared to the diagnostic biopsies prior the treatment, we documented a shift in the hormonal receptors profile toward a higher expression of progesterone and estrogen receptors in the endometriotic lesions.
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Affiliation(s)
| | - Arrigo Fruscalzo
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, Fribourg, Switzerland
| | - Fathi Khomsi
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, Fribourg, Switzerland
| | - Emanuela Stochino Loi
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, Fribourg, Switzerland
| | - Floryn Cherbanyk
- Department of General Surgery, University Hospital of Fribourg, Fribourg, Switzerland
| | - Jean Marc Ayoubi
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, Fribourg, Switzerland.,Department of Obstetrics and Gynecology and Reproductive Medicine, Hôpital Foch, Suresnes, France
| | - Anis Feki
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, Fribourg, Switzerland
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15
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Huang X, Guan J, Sheng Z, Wang M, Xu T, Guo G, Wan P, Tian B, Zhou J, Huang A, Hao J, Yao L. Effect of local anti-vascular endothelial growth factor therapy to prevent the formation of stenosis in outflow vein in arteriovenous fistula. J Transl Int Med 2021; 9:307-317. [PMID: 35136729 PMCID: PMC8802407 DOI: 10.2478/jtim-2021-0045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vascular stenosis and angiogenesis are the major causes of short expectancy of arteriovenous fistula (AVF). Increased expression of vascular endothelial growth factor-A (VEGF-A) has been suggested to play an important role in the pathophysiologic process. Anti-VEGF has been proved to be effective on anti-angiogenesis and applied in clinical practice, but its effect on anti-stenosis remains to be verified before it could be applied to prevent stenosis of AVF. This study was aimed to evaluate the effect of local anti-VEGF therapy to prevent the formation of stenosis in the outflow vein in AVF and its mechanism. METHODS Bioinformatics of VEGF-A and its downstream-regulated molecules from the STRING PPI database were analyzed in this study. The biopsy samples from outflow veins of AVF in patients and C57BL/6 mouse models were analyzed to examine the mechanisms of pathologic vascular stenosis associated with VEGF pathways and their potential therapeutic targets. RESULTS We found that the reduction of VEGF-A could downregulate downstream molecules and subsequently reduce the intimal hyperplasia and abnormal vascular remodeling by analyzing the STRING PPI database. Venous wall thickening, intimal neointima formation, and apoptosis of vascular endothelial cells in the proliferative outflow vein of the AVF were significantly more obvious, and upregulation of expression of VEGF was observed in dysfunctional AVF in patients. In mouse models, the expression of VEGF, Ephrin receptor B4 (EphB4), matrix metalloproteinase (MMP)2, MMP9, tissue inhibitor of metalloproteinase (TIMP)1, TIMP2, and caspase 3 in the control-shRNA surgical group was significantly higher than in the sham group (P < 0.05), and all of these indicators were significantly lower in lentiviral transfection group and Avastin group than in control-shRNA surgical group (P < 0.05) on the 14th day after AVF operation. CONCLUSION VEGF expression is significantly increased in vascular endothelial cells in stenosed or occluded outflow veins of dysfunctional AVF. Local injection of Avastin into the adventitia of the proximal outflow vein in autologous AVF procedure has an excellent potential to prevent the subsequent local stenosis of the proximal outflow vein.
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Affiliation(s)
- Xin Huang
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
| | - Jibin Guan
- College of Pharmacy, University of Minnesota, Minneapolis55455, MN, USA
| | - Zitong Sheng
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
| | - Menghua Wang
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
| | - Tianhua Xu
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
| | - Guangying Guo
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
| | - Pengzhi Wan
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
| | - Binyao Tian
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
| | - Junlei Zhou
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
| | - Aoran Huang
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
| | - Junfeng Hao
- Department of Nephrology, Jinqiu Hospital Liaoning Province, Shenyang110016, Liaoning Province, China
| | - Li Yao
- Department of Nephrology, The First Hospital of China Medical University, Shenyang110001, Liaoning Province, China
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16
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Wernicke AG, Taube S, Smith AW, Herskovic A, Parashar B, Schwartz TH. Cs-131 brachytherapy for patients with recurrent glioblastoma combined with bevacizumab avoids radiation necrosis while maintaining local control. Brachytherapy 2020; 19:705-12. [PMID: 32928486 DOI: 10.1016/j.brachy.2020.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Re-irradiation of recurrent glioblastoma (GBM) may delay further recurrence but re-irradiation increases the risk of radionecrosis (RN). Salvage therapy should focus on balancing local control (LC) and toxicity. We report the results of using intraoperative Cesium-131 (Cs-131) brachytherapy for recurrent GBM in a population of patients who also received bevacizumab. METHODS AND MATERIALS Twenty patients with recurrent GBM underwent maximally safe neurosurgical resection with Cs-131 brachytherapy between 2010 and 2015. Eighty Gy was prescribed to 0.5 cm from the surface of the resection cavity. All patients previously received adjuvant radiotherapy and temozolomide, and received bevacizumab before or after salvage brachytherapy. Seven of 20 (35%) tumors were multiply recurrent and had been previously salvaged with external beam radiotherapy. Patients received MRI scans every 2 months monitored for recurrence, progression, and RN. RESULTS Median tumor diameter was 4.65 cm (range, 1.2-6.3 cm). Median number of seeds pace was 41 (range, 20-74) with total seed activity 96.8U (range, 41.08-201.3U). At a median followup of 19 months, crude LC was 85% and median overall survival was 9 months (range, 5-26 months). There were two postoperative wound infections (10%), three seizures (15%), and 0% incidence of RN. CONCLUSIONS Our study demonstrates that while LC and survival are similar to other studies of postoperative external beam radiotherapy, no RN occurred in any of these patients, including 7 multiply re-irradiated patients. Of interest, there were patients with multiple recurrences whose survival extended beyond 20 months. These findings suggest that the use of highly conformal Cs-131 brachytherapy is a promising treatment for patients with recurrent GBM with minimal risk of development of RN.
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17
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Guo CH, Hsia S, Chung CH, Lin YC, Shih MY, Chen PC, Hsu GSW, Fan CT, Peng CL. Combination of Fish Oil and Selenium Enhances Anticancer Efficacy and Targets Multiple Signaling Pathways in Anti-VEGF Agent Treated-TNBC Tumor-Bearing Mice. Mar Drugs 2021; 19:193. [PMID: 33805447 PMCID: PMC8065403 DOI: 10.3390/md19040193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 12/19/2022] Open
Abstract
Fish oil (FO) and selenium (Se) possess antiangiogenic potential in malignant tumors. This study aimed to determine whether combination of FO and Se enhanced treatment efficacy of low-dose antiangiogenic agent Avastin (bevacizumab) in a dose-dependent manner and targeted multiple signaling pathways in triple-negative breast cancer (TNBC)-bearing mice. Randomized into five groups, mice received treatment with either physiological saline (control), Avastin alone, or Avastin in combination with low, medium, and high doses of FO/Se. The target signaling molecules for anticancer were determined either by measuring protein or mRNA expression. Avastin-treated mice receiving FO/Se showed lower tumor growth and metastasis than did mice treated with Avastin alone. Combination-treated mice exhibited lower expressions in multiple proangiogenic (growth) factors and their membrane receptors, and altered cytoplasmic signaling molecules (PI3K-PTEN-AKT-TSC-mTOR-p70S6K-4EBP1, Ras-Raf-MEK-ERK, c-Src-JAK2-STAT3-TMEPAI-Smad, LKB1-AMPK, and GSK3β/β-catenin). Dose-dependent inhibition of down-stream targets including epithelial-to-mesenchymal transition transcription factors, nuclear cyclin and cyclin-dependent kinases, cancer stem cell markers, heat shock protein (HSP-90), hypoxia-inducible factors (HIF-1α/-2α), matrix metalloprotease (MMP-9), and increased apoptosis were observed. These results suggest that combination treatment with FO and Se increases the therapeutic efficacy of Avastin against TNBC in a dose-dependent manner through multiple signaling pathways in membrane, cytoplasmic, and nucleic targets.
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Affiliation(s)
- Chih-Hung Guo
- Micronutrition and Biomedical Nutrition Laboratories, Institute of Biomedical Nutrition, Hung-Kuang University, Taichung 433, Taiwan; (C.-H.C.); (Y.-C.L.); (M.-Y.S.)
- Taiwan Nutraceutical Association, Taipei 105, Taiwan; (S.H.); (P.-C.C.); (C.-T.F.); (C.-L.P.)
| | - Simon Hsia
- Taiwan Nutraceutical Association, Taipei 105, Taiwan; (S.H.); (P.-C.C.); (C.-T.F.); (C.-L.P.)
| | - Chieh-Han Chung
- Micronutrition and Biomedical Nutrition Laboratories, Institute of Biomedical Nutrition, Hung-Kuang University, Taichung 433, Taiwan; (C.-H.C.); (Y.-C.L.); (M.-Y.S.)
- Taiwan Nutraceutical Association, Taipei 105, Taiwan; (S.H.); (P.-C.C.); (C.-T.F.); (C.-L.P.)
| | - Yi-Chun Lin
- Micronutrition and Biomedical Nutrition Laboratories, Institute of Biomedical Nutrition, Hung-Kuang University, Taichung 433, Taiwan; (C.-H.C.); (Y.-C.L.); (M.-Y.S.)
- Taiwan Nutraceutical Association, Taipei 105, Taiwan; (S.H.); (P.-C.C.); (C.-T.F.); (C.-L.P.)
| | - Min-Yi Shih
- Micronutrition and Biomedical Nutrition Laboratories, Institute of Biomedical Nutrition, Hung-Kuang University, Taichung 433, Taiwan; (C.-H.C.); (Y.-C.L.); (M.-Y.S.)
- Taiwan Nutraceutical Association, Taipei 105, Taiwan; (S.H.); (P.-C.C.); (C.-T.F.); (C.-L.P.)
| | - Pei-Chung Chen
- Taiwan Nutraceutical Association, Taipei 105, Taiwan; (S.H.); (P.-C.C.); (C.-T.F.); (C.-L.P.)
| | - Guoo-Shyng W. Hsu
- Human Ecology College, Fu Jen Catholic University, New Taipei City 242, Taiwan;
| | - Ciou-Ting Fan
- Taiwan Nutraceutical Association, Taipei 105, Taiwan; (S.H.); (P.-C.C.); (C.-T.F.); (C.-L.P.)
| | - Chia-Lin Peng
- Taiwan Nutraceutical Association, Taipei 105, Taiwan; (S.H.); (P.-C.C.); (C.-T.F.); (C.-L.P.)
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18
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Sidell DR, Balakrishnan K, Best SR, Zur K, Buckingham J, De Alarcon A, Baroody FM, Bock JM, Boss EF, Bower CM, Campisi P, Chen SF, Clarke JM, Clarke KD, Cocciaglia A, Cotton RT, Cuestas G, Davis KL, DeFago VH, Dikkers FG, Dossans I, Florez W, Fox E, Friedman AD, Grant N, Hamdi O, Hogikyan ND, Johnson K, Johnson LB, Johnson RF, Kelly P, Klein AM, Lawlor CM, Leboulanger N, Levy AG, Lam D, Licameli GR, Long S, Lott DG, Manrique D, McMurray JS, Meister KD, Messner AH, Mohr M, Mudd P, Mortelliti AJ, Novakovic D, Ongkasuwan J, Peer S, Piersiala K, Prager JD, Pransky SM, Preciado D, Raynor T, Rinkel RNPM, Rodriguez H, Rodríguez VP, Russell J, Scatolini ML, Scheffler P, Smith DF, Smith LP, Smith ME, Smith RJH, Sorom A, Steinberg A, Stith JA, Thompson D, Thompson JW, Varela P, White DR, Wineland AM, Yang CJ, Zdanski CJ, Derkay CS. Systemic Bevacizumab for Treatment of Respiratory Papillomatosis: International Consensus Statement. Laryngoscope 2021; 131:E1941-E1949. [PMID: 33405268 DOI: 10.1002/lary.29343] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality. STUDY DESIGN Delphi method-based survey series. METHODS A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work-up. RESULTS The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics (22), and Prior Workup Characteristics (18). CONCLUSION This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best-practice applications of systemic bevacizumab for patients with early-onset or less-severe disease phenotypes. LEVEL OF EVIDENCE 5 Laryngoscope, 131:E1941-E1949, 2021.
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Affiliation(s)
- Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, and, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Karen Zur
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Julia Buckingham
- Maternal and Child Health Research Institute, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford University, Stanford, California, U.S.A
| | - Alessandro De Alarcon
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery and Department of Pediatrics, University of Chicago Medicine and The Comer Children's Hospital, Chicago, Illinois, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology and Communication Sciences, Division of Laryngology and Professional Voice, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery and the Department of Health Policy and Management, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Charles M Bower
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences (UAMS), Arkansas Children's Hospital, Little Rock, Alaska, U.S.A
| | - Paolo Campisi
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Sharon F Chen
- Department of Pediatrics, Division of Infectious Diseases, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Jeffrey M Clarke
- Department of Medicine, Division of Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Kevin D Clarke
- Pediatric Otolaryngology, Division of Otolaryngology Head and Neck Surgery, University of British Columbia (UBC, UVIc), Victoria General Hospital, Victoria, British Columbia, Canada
| | - Alejandro Cocciaglia
- ENT-Respiratory Endoscopy Department, Garrahan Children's Hospital, Buenos Aires, Argentina
| | - Robin T Cotton
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Giselle Cuestas
- Respiratory Endoscopy Section, ENT Department, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
| | - Kara L Davis
- Department of Pediatrics, Division of Pediatric Oncology, Bass Center for Childhood Cancer and Blood Disorders, Stanford University, Stanford, California, U.S.A
| | - Victor H DeFago
- Pediatric Surgery, Sanatorio del Salvador Privado SA, Cordoba, Argentina
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ines Dossans
- Otolaryngology-Head and Neck Surgery, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Walter Florez
- Department of Otolaryngology, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru
| | - Elizabeth Fox
- Comprehensive Cancer Center, St Jude Children's Research Hospital, Memphis, Tennessee, U.S.A
| | - Aaron D Friedman
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, U.S.A
| | - Nazaneen Grant
- Department of Otolaryngology, Division of Laryngology, Medstar Georgetown University Hospital, Georgetown, Washington, District of Columbia, U.S.A
| | - Osama Hamdi
- Howard University College of Medicine, Washington, District of Columbia, U.S.A
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Kaalan Johnson
- University of Washington School of Medicine, Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, Seattle, Washington, District of Columbia, U.S.A
| | - Liane B Johnson
- Department of Surgery, Dalhousie University, Division of Paediatric Otolaryngology-Head and Neck Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Peggy Kelly
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Children's Hospital Colorado affiliated with University of Colorado, Anschutz, Aurora, Colorado, U.S.A
| | - Adam M Klein
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Claire M Lawlor
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Nicolas Leboulanger
- Head and Neck Surgery, Pediatric Otolaryngology, Necker Enfants Malades Hospital, Paris University, Paris, France
| | - Alejandro G Levy
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Arnold Palmer Hospital Center for Children's Cancer and Blood Disorders, Orlando Health, Orlando, Florida, U.S.A
| | - Derek Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Greg R Licameli
- Department of Otolaryngology, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Steve Long
- Department of Head and Neck Surgery, Kaiser Permanente, Hillsboro, Oregon, U.S.A
| | - David G Lott
- Department of Otorhinolaryngology, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Dayse Manrique
- Department of Otorhinolaryngology, Universidad Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - James Scott McMurray
- Pediatric Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Anna H Messner
- Department of Otolaryngology/Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Michael Mohr
- Department of Hematology, Oncology and Respiratory Medicine, University Hospital Muenster, Muenster, Germany
| | - Pamela Mudd
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Anthony J Mortelliti
- Department of Otolaryngology-Head and Neck Surgery, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, U.S.A
| | - Daniel Novakovic
- Department of Otolaryngology, Head and Neck Surgery, Central Clinical School, Faculty of Medicine and Health, University of Sydney, The Canterbury Hospital, Sydney, New South Wales, Australia
| | - Julian Ongkasuwan
- Department of Otolaryngology, Division of Adult and Pediatric Laryngology, Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Shazia Peer
- Division of Otorhinolaryngology, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Krysztof Piersiala
- Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinksa University Hospital, Stockholm, Sweden
| | - Jeremy D Prager
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, Children's Hospital Colorado affiliated with University of Colorado, Anschutz, Aurora, Colorado, U.S.A
| | | | - Diego Preciado
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's National Health System, George Washington University School of Medicine, Washington, District of Columbia, U.S.A
| | - Tiffany Raynor
- Department of Otolaryngology, Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Rico N P M Rinkel
- Department of Otolaryngology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hugo Rodriguez
- Respiratory Endoscopy Department, Hospital de Pediatria Prof Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Verónica P Rodríguez
- Respiratory Endoscopy Section, ENT Department, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
| | - John Russell
- Department of Paediatric Otolaryngology, Children's Health Ireland, Dublin, Ireland
| | - María Laura Scatolini
- Respiratory Endoscopy Department, Hospital de Pediatria Prof Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Patrick Scheffler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - David F Smith
- Divisions of Pediatric Otolaryngology, Pulmonary Medicine, and the Sleep Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Lee P Smith
- Division of Otolaryngology-Head and Neck Surgery, Pediatric Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York, U.S.A
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Richard J H Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Abraham Sorom
- Otolaryngology, Head and Neck Surgery, Confluence Health, Wenatchee, Washington, District of Columbia, U.S.A
| | - Amalia Steinberg
- Otolaryngology, Head and Neck Surgery, Alaska Native Medical center, Anchorage, Alaska, U.S.A
| | - John A Stith
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, SSM Cardinal Glennon Children's Hospital Medical Center, St. Louis, Missouri, U.S.A
| | - Dana Thompson
- Division of Pediatric Otolaryngology Head and Neck Surgery Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Jerome W Thompson
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric ENT, LeBonheur Children's Hospital, College of Medicine, University of Tennnessee, Memphis, Tennessee, U.S.A
| | - Patricio Varela
- Pediatric Surgery Department, Universidad de Chile, Mackenna Children Hospital, Clinica Las Condes Medical center, Santiago, Chile
| | - David R White
- Division of Pediatric Otolaryngology, Medical University of South Carolina (MUSC) Shawn Jenkins Children's Hospital, Charleston, South Carolina, U.S.A
| | - Andre M Wineland
- Department of Otolaryngology-Head and Neck Surgery and the Department of Health Policy and Management, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Christina J Yang
- Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Children's Hospital at Montefiore, New York, New York, U.S.A
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, Division of Pediatric Otolaryngology/Head and Neck Surgery, North Carolina Children's Hospital, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, U.S.A
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Duggan TJ, Cai CL, Aranda JV, Beharry KD. Acute and chronic effects of intravitreal bevacizumab on lung biomarkers of angiogenesis in the rat exposed to neonatal intermittent hypoxia. Exp Lung Res 2020; 47:121-135. [PMID: 33377400 DOI: 10.1080/01902148.2020.1866712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE/AIM Intravitreal bevacizumab (Avastin) is an irreversible vascular endothelial growth factor (VEGF) inhibitor used to treat severe retinopathy of prematurity (ROP) in extremely low gestational age neonates (ELGANs). ELGANs who are at the highest risk for developing severe ROP often experience brief intermittent hypoxia (IH) episodes which may cause oxidative damage. We tested the hypothesis that intravitreal Avastin leaks into the systemic circulation during exposure to IH and has adverse effects on biomarkers of pulmonary microvascular maturation, thus leading to pulmonary hemorrhage and long-term pulmonary sequelae. METHODS Neonatal rats at postnatal day (PN) 0 (birth) were exposed to either: 1) hyperoxia (50% O2) or 2) neonatal IH (50% O2 with brief episodes of 12% O2) from PN0 to PN14. Room air (RA) littermates served as controls. At PN14, the time of eye opening in rats, a single dose of Avastin (0.125 mg in 5 µL) was injected into the vitreous cavity of the left eyes. A control group received equivalent volume saline. At PN23 and PN45, blood gases, lung-to-body weight ratios, histology, immunofluorescence, and lung biomarkers of angiogenesis were examined. RESULTS At PN23, Avastin increased lung VEGF, nitric oxide derivatives (NOx), and hypoxia-inducible factor (HIF)1a in the hyperoxia-exposed groups, but decreased soluble VEGFR-1 (sVEGFR-1). At PN45, lungs from animals exposed to neonatal IH and treated with Avastin were severely hemorrhagic with morphologic changes in lung architecture consistent with chronic lung disease. This was associated with higher VEGF and NOx levels, and lower insulin-like growth factor (IGF)-I and sVEGFR-1. CONCLUSIONS These findings prove our hypothesis that intravitreal Avastin penetrates the blood-ocular barrier in IH and alters lung biomarkers of angiogenesis. Avastin targeting of VEGF could affect normal lung development which may be exaggerated under pathologic conditions such as IH, ultimately leading to vascular permeability, vessel rupture, and pulmonary hemorrhage.
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Affiliation(s)
- Thomas J Duggan
- aDepartment of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Charles L Cai
- aDepartment of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Jacob V Aranda
- aDepartment of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.,Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.,State University of New York Eye Institute, Brooklyn, New York, USA
| | - Kay D Beharry
- aDepartment of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.,Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.,State University of New York Eye Institute, Brooklyn, New York, USA
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20
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Park D, Kim J, Yun J, Park SJ. Evaluation of the Physico-Chemical and Biological Stability of SB8 (Aybintio), a Proposed Biosimilar to Bevacizumab, Under Ambient and In-Use Conditions. Adv Ther 2020; 37:4308-4324. [PMID: 32816233 DOI: 10.1007/s12325-020-01465-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION No stability data of SB8 (proposed biosimilar to bevacizumab) are available for opened vials at 2-8 °C or for unopened vials stored outside of this range. Furthermore, limited stability data are available for dilutions. Stability of unopened vials of SB8 at ambient temperature and in-use stability for opened vials as well as diluted SB8 in infusion bags were evaluated. METHODS SB8 stability was assessed in three scenarios in the absence of light: unopened 100-mg vials 36 months after manufacture stored at 30 ± 2 °C with 65 ± 5% relative humidity for 1 month, opened 100-mg and 400-mg vials stored at 5 ± 3 °C for 72 h and diluted (1.4 mg/ml or 16.5 mg/ml in 100 ml 0.9% NaCl polyolefin bags) stored for 45 days at 5 ± 3 °C and then 3 days at 30 ± 2 °C; the United Kingdom's National Health Service protocol was used for the study design after dilution. Physicochemical stability (appearance, pH, protein concentration, size-exclusion high-performance liquid chromatography, non-reducing capillary electrophoresis-sodium dodecyl sulfate, imaged capillary isoelectric focusing), biological activity [vascular endothelial growth factor (VEGF) neutralization assay, VEGF binding assay] and potential safety impact properties (subvisible particulates, submicronic aggregation by dynamic light scattering) were determined. RESULTS All stability-indicating criteria including those for biological activity were met for both unopened vials at ambient condition and for in-use conditions of opened vials as well as both dilutions. No noteworthy changes in terms of physicochemical stability, biological activity and properties with a potential safety impact occurred. CONCLUSION Under the studied aspetic extreme conditions, SB8 was stable. Our data may support advanced SB8 preparation and may help prevent SB8 wastage because of exceptional temperature excursions or unused product. Sterility assurance is the responsibility of the user and is of utmost importance when opened or diluted SB8 is not immediately used.
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Affiliation(s)
- Dongkuk Park
- Quality Evaluation Team, Samsung Bioepis Co., Ltd., 107, Cheomdan-daero, Yeonsu-gu, Incheon, 21987, Republic of Korea
| | - Jihyun Kim
- Quality Evaluation Team, Samsung Bioepis Co., Ltd., 107, Cheomdan-daero, Yeonsu-gu, Incheon, 21987, Republic of Korea
| | - Jihoon Yun
- Quality Evaluation Team, Samsung Bioepis Co., Ltd., 107, Cheomdan-daero, Yeonsu-gu, Incheon, 21987, Republic of Korea
| | - Su Jin Park
- Quality Evaluation Team, Samsung Bioepis Co., Ltd., 107, Cheomdan-daero, Yeonsu-gu, Incheon, 21987, Republic of Korea.
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21
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Ryan MA, Leu GR, Upchurch PA, Tunkel DE, Walsh JM, Boss EF. Systemic Bevacizumab ( Avastin) for Juvenile-Onset Recurrent Respiratory Papillomatosis: A Systematic Review. Laryngoscope 2020; 131:1138-1146. [PMID: 32959914 DOI: 10.1002/lary.29084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Juvenile onset recurrent respiratory papillomatosis (JORRP) can cause severe or disseminated disease. Surgical treatment may be inadequate. Systemic bevacizumab has shown initial success for severe JORRP. The objective of this systematic review was to assess usage, effectiveness, and safety of this treatment. METHODS We searched PubMed, Embase, and Web of Science for studies of humans with JORRP treated with systemic bevacizumab. Two researchers independently reviewed the studies to determine inclusion and aggregate data on patient characteristics, dosing protocols, treatment response, adverse events, and level of evidence. RESULTS Of 80 identified articles, 12 studies were included detailing 20 distinct cases. At a mean age of 12.8 years (range = 1-43 years) patients received initial dosing of 5 to 10 mg/kg of bevacizumab followed by ongoing doses at a mean 3-week intervals (range = 2-5 weeks). All patients had clinically significant disease reduction with reduced need for surgery. Six patients (30%) had complete response in at least one involved anatomic site. Eleven (55%) required no surgery after initiating treatment. There was recurrence in all four patients whose treatment was stopped, but had rapid improvement with treatment resumption. Six (30%) experienced mild or moderate adverse events. CONCLUSIONS Marked improvement in severe JORRP has been reported from systemic bevacizumab. Treatment protocols vary, and treatment discontinuation was not feasible in any reported patient. Based on currently available data, systemic bevacizumab can be considered for severe JORRP as it appears to be well tolerated and effective. A clinical trial could enhance the understanding of its safety and efficacy for this indication. Laryngoscope, 131:1138-1146, 2021.
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Affiliation(s)
- Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Grace R Leu
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Patrick A Upchurch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, U.S.A.,Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
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Singh I, Patel R, Patel A, Jose V. A randomized, double-blind, parallel-group, single‑dose, pharmacokinetic bioequivalence study of INTP24 and bevacizumab in healthy adult men. Cancer Chemother Pharmacol 2020; 86:193-202. [PMID: 32627073 DOI: 10.1007/s00280-020-04111-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To demonstrate pharmacokinetic (PK) equivalence and to compare safety of INTP24 (bevacizumab biosimilar) with that of US-bevacizumab and EU-bevacizumab in healthy male subjects. METHODS In this randomized, parallel-group, double-blind study, male subjects were randomized (1:1:1) to receive a single 1 mg/kg intravenous infusion of either INTP24, US-bevacizumab, or EU-bevacizumab. The primary endpoint was area under serum concentration (AUC) from time zero to infinity (AUC0-∞). Secondary endpoints were AUC from time zero to last quantifiable concentration (AUC0-t), maximum concentration (Cmax), other PK parameters, immunogenicity, and safety. RESULTS A total of 117 subjects (39/group) were dosed; 113 subjects (37, 37, and 39 in INPT24, US-bevacizumab, and EU-bevacizumab groups, respectively) completed the study and were included in the PK analysis. Baseline demographics were similar across the three groups. The 90% confidence intervals (CI) of geometric mean ratios (GMR) of ln-transformed AUC0-∞ and Cmax of INTP24 relative to US-bevacizumab and EU-bevacizumab were within the acceptance range of 80%-125% (INTP24 vs. US-bevacizumab, 96.55-112.51% and 99.16-112.79%: INTP24 vs. EU-bevacizumab, 94.84-110.17% and 96.32-109.28%). The 90% CIs of GMRs for AUC0-t was also within 80-125% for INTP24 vs. US-bevacizumab and INTP24 vs. EU-bevacizumab. Safety and immunogenicity profiles were similar across the three groups. Twenty-one (17.95%) subjects experienced at least one AE and 9 (7.69%) were ADA positive. One treatment-related serious adverse event (varicella zoster infection) was reported in INTP24 group. CONCLUSION This study demonstrated PK bioequivalence of INTP24 to US-bevacizumab and EU-bevacizumab in healthy male subjects and showed similar safety and immunogenicity profiles across the treatment groups.
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Affiliation(s)
- Inderjeet Singh
- Intas Pharmaceuticals Ltd. (Biopharma Division), Plot No: 423/P/A, Sarkhej-Bavla Highway, Moraiya, Sanand, Ahmedabad, Gujarat, 382213, India
| | - Ronak Patel
- Lambda Therapeutic Research Ltd., Lambda House, Plot No. 38, Survey No. 388, Near Silver Oak Club, S. G. Highway, Gota, Ahmedabad, Gujarat, 382481, India
| | - Akash Patel
- Lambda Therapeutic Research Ltd., Lambda House, Plot No. 38, Survey No. 388, Near Silver Oak Club, S. G. Highway, Gota, Ahmedabad, Gujarat, 382481, India
| | - Vinu Jose
- Intas Pharmaceuticals Ltd. (Biopharma Division), Plot No: 423/P/A, Sarkhej-Bavla Highway, Moraiya, Sanand, Ahmedabad, Gujarat, 382213, India.
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23
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Appanraj R, Duraiswamy H, Saravanan V, Manayath G, Venkatapathy N. Intravitreal bevacizumab for iatrogenic choroidal neovascular membrane following vitreoretinal surgery for retinal detachment. Indian J Ophthalmol 2020; 68:1201-1203. [PMID: 32461482 PMCID: PMC7508106 DOI: 10.4103/ijo.ijo_1486_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the successful use of intravitreal bevacizumab in the iatrogenic choroidal neovascular membrane (CNVM) following vitreoretinal surgery. A 69-year-old male underwent vitrectomy surgery with silicone oil (SO) tamponade for rhegmatogenous retinal detachment. During fluid air exchange, there was an accidental retinal touch at an area in the papillomacular bundle with the silicone tip cannula. He had persistent subretinal bleed at the area 1 month after surgery. The optical coherence tomography (OCT) showed a subretinal elevated lesion and fluorescein angiography (FFA) showed an active CNVM. The patient was treated with intravitreal bevacizumab in the SO-filled eye. At 1-month postinjection, the OCT revealed reduction in the size of CNVM. The patient underwent SO removal with the second dose of intravitreal bevacizumab. CNVM regressed with no recurrence on follow-up at 1 year. Iatrogenic CNVM is a rare complication following successful vitreoretinal surgery. Prompt diagnosis and treatment with intravitreal bevacizumab may be required for a favorable outcome. Iatrogenic choroidal neovascular membrane (CNVM) is an uncommon condition usually associated with retinal laser or iatrogenic trauma during vitrectomy. Very few cases of iatrogenic CNVM have been reported in the literature, and the functional outcome has generally been poor in these reports despite treatment with laser photocoagulation, intravitreal bevacizumab, photodynamic therapy, and surgical removal of neovascular membranes. We report this case to highlight this rare complication following vitrectomy and its response to antivascular endothelial growth facor (VEGF) therapy.
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Affiliation(s)
- Ramya Appanraj
- Department of Retina and Vitreous, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India
| | - Hema Duraiswamy
- Department of Retina and Vitreous, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India
| | - Veerappan Saravanan
- Department of Retina and Vitreous, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India
| | - George Manayath
- Department of Retina and Vitreous, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India
| | - Narendran Venkatapathy
- Department of Retina and Vitreous, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India
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Garcia J, Hurwitz HI, Sandler AB, Miles D, Coleman RL, Deurloo R, Chinot OL. Bevacizumab ( Avastin®) in cancer treatment: A review of 15 years of clinical experience and future outlook. Cancer Treat Rev 2020; 86:102017. [PMID: 32335505 DOI: 10.1016/j.ctrv.2020.102017] [Citation(s) in RCA: 478] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/01/2023]
Abstract
When the VEGF-A-targeting monoclonal antibody bevacizumab (Avastin®) entered clinical practice more than 15 years ago, it was one of the first targeted therapies and the first approved angiogenesis inhibitor. Marking the beginning for a new line of anti-cancer treatments, bevacizumab remains the most extensively characterized anti-angiogenetic treatment. Initially approved for treatment of metastatic colorectal cancer in combination with chemotherapy, its indications now include metastatic breast cancer, non-small-cell lung cancer, glioblastoma, renal cell carcinoma, ovarian cancer and cervical cancer. This review provides an overview of the clinical experience and lessons learned since bevacizumab's initial approval, and highlights how this knowledge has led to the investigation of novel combination therapies. In the past 15 years, our understanding of VEGF's role in the tumor microenvironment has evolved. We now know that VEGF not only plays a major role in controlling blood vessel formation, but also modulates tumor-induced immunosuppression. These immunomodulatory properties of bevacizumab have opened up new perspectives for combination therapy approaches, which are being investigated in clinical trials. Specifically, the combination of bevacizumab with cancer immunotherapy has recently been approved in non-small-cell lung cancer and clinical benefit was also demonstrated for treatment of hepatocellular carcinoma. However, despite intense investigation, reliable and validated biomarkers that would enable a more personalized use of bevacizumab remain elusive. Overall, bevacizumab is expected to remain a key agent in cancer therapy, both due to its established efficacy in approved indications and its promise as a partner in novel targeted combination treatments.
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Affiliation(s)
- Josep Garcia
- Global Clinical Development, F. Hoffmann-La Roche Ltd., Basel, Switzerland.
| | | | | | | | - Robert L Coleman
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas, MD Anderson Cancer Center, TX, USA
| | - Regula Deurloo
- Oncology Biomarker Development, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Olivier L Chinot
- Aix-Marseille University, Assistance Publique-Hopitaux de Marseille, Centre Hospitalo-Universitaire Timone, Service de Neuro-Oncologie, Marseille, France
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25
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Kurra P, Brazionis L, Gale J, Chen K, Lake S, Robledo KP, Henderson T. Visual Outcomes in the Management of Diabetic Maculopathy in Central Australia. Ophthalmic Epidemiol 2020; 27:265-271. [PMID: 32070176 DOI: 10.1080/09286586.2020.1730909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE In major urban centres and high-resource settings, treatment of diabetic maculopathy with anti-Vascular Endothelial Growth Factor (VEGF) injections has largely displaced laser treatment. However, intravitreal therapy alone requires frequent follow-up, a barrier to adherence in remote Australia. We report vision outcomes of phased diabetic maculopathy treatment in remote Central Australia for maculopathy using laser and, in a subset, supplementary injection treatment. METHODS We audited clinical records of patients undergoing laser treatment for diabetic maculopathy between 2001 and 2013 at an ophthalmology service based at Alice Springs Hospital, a regional hub in remote Australia. All patients receiving macular laser treatment were included, and some required supplementary injection(s). The primary outcome measure was change in best-corrected visual acuity [BCVA] from baseline treatment. RESULTS Of 338 maculopathy-treated patients, 88% were indigenous and 39% were male. Of 554 maculopathy laser-treated eyes, 118 (21%) received supplementary injection/s. In the laser treatment phase, median BCVA was 78 letters at baseline (interquartile range 62-80) and decreased by a median of two letters at final visit. In the subset who underwent subsequentinjection treatment, BCVA was 60 letters at first injection, with a median five-letter increase by final visit. Overall outcomes were similar in Indigenous and non-Indigenous Australians. Predictors of reduction in BCVA in the macular laser treatment phase were better baseline BCVA, older age, and PRP treatment (all p < .005). CONCLUSION Laser treatment for diabetic maculopathy preserved vision in Central Australia, where barriers to follow-up can preclude regular injections. Supplementary injections stabilized vision in the laser-resistant subset.
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Affiliation(s)
- Pavani Kurra
- Department of Ophthalmology, Alice Springs Hospital , Alice Springs, Australia
| | - Laima Brazionis
- NHMRC Clinical Trials Centre, The University of Sydney , Sydney, Australia.,Department of Medicine, The University of Melbourne , Melbourne, Australia
| | - Jesse Gale
- Department of Ophthalmology, Alice Springs Hospital , Alice Springs, Australia.,Surgery and Anaesthesia, University of Otago , Wellington, New Zealand
| | - Katie Chen
- Department of Ophthalmology, Alice Springs Hospital , Alice Springs, Australia
| | - Stewart Lake
- Department of Ophthalmology, Alice Springs Hospital , Alice Springs, Australia.,Department of Medicine, The University of Melbourne , Melbourne, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, The University of Sydney , Sydney, Australia
| | - Tim Henderson
- Department of Ophthalmology, Alice Springs Hospital , Alice Springs, Australia.,Department of Ophthalmology, Flinders Medical Centre , Adelaide, Australia
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26
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Brolucizumab (Beovu) for age-related macular degeneration. Med Lett Drugs Ther 2020; 62:23-4. [PMID: 32022789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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27
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Lu VM, Welby JP, Nesvick CL, Daniels DJ. Efficacy and safety of bevacizumab in progressive pediatric low-grade glioma: a systematic review and meta-analysis of outcome rates. Neurooncol Pract 2020; 7:359-368. [PMID: 33282324 DOI: 10.1093/nop/npz076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Successful management of pediatric low-grade glioma (pLGG) can be complicated by eloquent anatomical location, as well as specific pathologic and molecular features. Some authors have proposed using the VEGF inhibitor bevacizumab to improve disease control, but its safety and efficacy are poorly defined. Correspondingly, our aim was to pool systematically identified clinical data in the literature to assess the clinical utility of bevacizumab for pLGG at progression. Methods A systematic search of 7 electronic databases from inception to June 2019 was conducted following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Articles were screened against prespecified criteria. Outcomes were then pooled by random-effects meta-analyses of proportions. Results Seven pertinent studies described the outcomes of 110 progressive pLGG patients managed with bevacizumab in largely multiagent regimens. While on treatment, the rate of clinical response was 58% (95% CI, 43%-72%), and the rate of response on imaging was 80% (95% CI, 58%-96%). The rate of grade 3 or higher toxicity was 8% (95% CI, 2%-17%), with proteinuria the most commonly described. In the off-treatment period up to median 1 year, the rate of progression was estimated to be 51% (95% CI, 28%-74%). Conclusions Bevacizumab has the potential to control clinical and radiographic disease with relatively low grade 3 or higher toxicity risk in progressive pLGG patients. However, the long-term off-treatment benefits of this therapy are not yet well defined. Heterogeneity in the literature precludes any formal recommendations regarding its use until larger, more standardized investigations can be performed.
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Affiliation(s)
- Victor M Lu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - John P Welby
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Cody L Nesvick
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
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Bro T, Derebecka M, Jørstad ØK, Grzybowski A. Off-label use of bevacizumab for wet age-related macular degeneration in Europe. Graefes Arch Clin Exp Ophthalmol 2019; 258:503-511. [PMID: 31889214 DOI: 10.1007/s00417-019-04569-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/27/2019] [Accepted: 12/12/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To analyse current off-label use of bevacizumab for wet age-related macular degeneration (AMD) in Europe. METHODS The study was conducted as a combined survey and literature review. It included the 22 most populous countries in Europe. In each country, ophthalmologists with particular knowledge about off-label treatment responded to a questionnaire. RESULTS Answers were obtained from twenty European countries. The off-label use of bevacizumab for wet AMD greatly differed between nations; the bevacizumab proportion varied from non-existent (0%) to very high (97%). There were also large disparities within single countries (e.g. 0-80%), which were attributable to differences in regional decision-making. Both governmental institutions and national ophthalmological societies expressed highly diverging opinions on the use of off-label treatment. Intravitreal administration of bevacizumab had been a matter of legal dispute in several countries. The question about responsibility for off-label therapy mainly remained unanswered. CONCLUSIONS There was a highly varying utilization of bevacizumab between European countries. Despite an intention of a consistent approach to medical regulations, Europe has not yet reached a professional or political consensus on the ophthalmic off-label use of bevacizumab.
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Affiliation(s)
- Tomas Bro
- Futurum, the Academy for Health and Care in Region Jönköping, Jönköping, Sweden. .,Ögonmottagningen, Höglandssjukhuset, 575 81, Eksjö, Sweden.
| | | | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Andrzej Grzybowski
- University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
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Chakravarthy AB, Zhao F, Meropol NJ, Flynn PJ, Wagner LI, Sloan J, Diasio RB, Mitchell EP, Catalano P, Giantonio BJ, Catalano RB, Haller DG, Awan RA, Mulcahy MF, O'Brien TE, Santala R, Cripps C, Weis JR, Atkins JN, Leichman CG, Petrelli NJ, Sinicrope FA, Brierley JD, Tepper JE, O'Dwyer PJ, Sigurdson ER, Hamilton SR, Cella D, Benson AB. Intergroup Randomized Phase III Study of Postoperative Oxaliplatin, 5-Fluorouracil, and Leucovorin Versus Oxaliplatin, 5-Fluorouracil, Leucovorin, and Bevacizumab for Patients with Stage II or III Rectal Cancer Receiving Preoperative Chemoradiation: A Trial of the ECOG-ACRIN Research Group (E5204). Oncologist 2019; 25:e798-e807. [PMID: 31852811 DOI: 10.1634/theoncologist.2019-0437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The addition of bevacizumab to chemotherapy improved outcomes for patients with metastatic colon cancer. E5204 was designed to test whether the addition of bevacizumab to mFOLFOX6, following neoadjuvant chemoradiation and definitive surgery, could improve overall survival (OS) in patients with stage II/III adenocarcinoma of the rectum. SUBJECTS, MATERIALS, AND METHODS Patients with stage II/III rectal cancer who had completed neoadjuvant 5-fluorouracil-based chemoradiation and had undergone complete resection were enrolled. Patients were randomized to mFOLFOX6 (Arm A) or mFOLFOX6 with bevacizumab (Arm B) administered every 2 weeks for 12 cycles. RESULTS E5204 registered only 355 patients (17% of planned accrual goal) as it was terminated prematurely owing to poor accrual. At a median follow-up of 72 months, there was no difference in 5-year overall survival (88.3% vs. 83.7%) or 5-year disease-free survival (71.2% vs. 76.5%) between the two arms. The rate of treatment-related grade ≥ 3 adverse events (AEs) was 68.8% on Arm A and 70.7% on Arm B. Arm B had a higher proportion of patients who discontinued therapy early as a result of AEs and patient withdrawal than did Arm A (32.4% vs. 21.5%, p = .029).The most common grade 3-4 treatment-related AEs were neutropenia, leukopenia, neuropathy, diarrhea (without prior colostomy), and fatigue. CONCLUSION At 17% of its planned accrual, E5204 did not meet its primary endpoint. The addition of bevacizumab to FOLFOX6 in the adjuvant setting did not significantly improve OS in patients with stage II/III rectal cancer. IMPLICATIONS FOR PRACTICE At 17% of its planned accrual, E5204 was terminated early owing to poor accrual. At a median follow-up of 72 months, there was no significant difference in 5-year overall survival (88.3% vs. 83.7%) or in 5-year disease-free survival (71.2% vs. 76.5%) between the two arms. Despite significant advances in the treatment of rectal cancer, especially in improving local control rates, the risk of distant metastases and the need to further improve quality of life remain a challenge. Strategies combining novel agents with chemoradiation to improve both distant and local control are needed.
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Affiliation(s)
| | - Fengmin Zhao
- ECOG-ACRIN Biostatistics Center, Boston, Massachusetts, USA
| | - Neal J Meropol
- Flatiron Health, New York, New York, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston Salem, North Carolina, USA
| | | | | | - Edith P Mitchell
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Paul Catalano
- ECOG-ACRIN Biostatistics Center, Boston, Massachusetts, USA
| | - Bruce J Giantonio
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | | | | | - Rashid A Awan
- University of Pittsburgh Cancer Institute (UPCI), Johnstown, Pennsylvania, USA
| | | | - Timothy E O'Brien
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Christine Cripps
- Ottawa Health Research Institute-General Division, Ottawa, Ontario, Canada
| | - John R Weis
- Huntsman Cancer Institute/University of Utah, Salt Lake City, Utah, USA
| | - James N Atkins
- Southeast Cancer Control Consortium, Winston-Salem, North Carolina, USA
| | - Cynthia G Leichman
- Laura and Issac Perlmutter Cancer Center at NYU Langone, New York, New York, USA
| | | | | | - James D Brierley
- University Health Network-Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Joel E Tepper
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | - David Cella
- Northwestern University, Chicago, Illinois, USA
| | - Al B Benson
- Northwestern University, Chicago, Illinois, USA
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Drugs for common eye disorders. Med Lett Drugs Ther 2019; 61:187-94. [PMID: 31770361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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31
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Tsiros D, Sheehy CE, Pecchia S, Nugent MA. Heparin potentiates Avastin-mediated inhibition of VEGF binding to fibronectin and rescues Avastin activity at acidic pH. J Biol Chem 2019; 294:17603-17611. [PMID: 31601651 DOI: 10.1074/jbc.ra119.009194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/08/2019] [Indexed: 12/27/2022] Open
Abstract
Vascular endothelial growth factor-A (VEGF) plays a critical role in stimulating angiogenesis in normal and disease states. Anti-VEGF antibodies have been developed to manage pathological angiogenesis. Bevacizumab, sold under the brand name Avastin, is a humanized mAb that binds VEGF and blocks its binding to its signaling receptor, VEGF receptor 2, and is used to treat patients with a variety of cancers or retinal disorders. The ability of Avastin to modulate other nonreceptor interactions of VEGF has not been fully defined. In this study, we investigated Avastin's capacity to modulate VEGF165 binding to porcine aortic endothelial cells and to heparin and fibronectin (FN) across a range of pH values (pH 5-8). We observed that Avastin slightly enhanced VEGF binding to heparin and that heparin increased VEGF binding to Avastin. In contrast, Avastin inhibited VEGF binding to cells and FN, yet Avastin could still bind to VEGF that was bound to FN, indicating that these binding events are not mutually exclusive. Avastin binding to VEGF was dramatically reduced at acidic pH values (pH 5.0-6.5), whereas VEGF binding to FN and nonreceptor sites on cells was enhanced. Interestingly, the reduced Avastin-VEGF binding at acidic pH was rescued by heparin, as was Avastin's ability to inhibit VEGF binding to cells. These results suggest that heparin might be used to expand the clinical utility of Avastin. Our findings highlight the importance of defining the range of VEGF interactions to fully predict antibody activity within a complex biological setting.
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Affiliation(s)
- Divyabharathy Tsiros
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, Massachusetts 01854
| | - Casey E Sheehy
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, Massachusetts 01854
| | - Surenna Pecchia
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, Massachusetts 01854
| | - Matthew A Nugent
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, Massachusetts 01854
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Nemati S, Keihanian F, Saeidinia A, Bakhshaei M. Effect Of Bevacizumab On Growth Of Human Nasal Polyposis In Vitro; An Off-Label Use Of Anti-Angiogenic Agent For Nasal Polyposis Treatment. Drug Des Devel Ther 2019; 13:3383-3389. [PMID: 31576112 PMCID: PMC6767760 DOI: 10.2147/dddt.s219724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/11/2019] [Indexed: 01/02/2023]
Abstract
Introduction Nasal polyposis (NP) is a frequent problem during adulthood. Treatment of NP is primarily based on drugs, such as oral or topical steroids and in some types, by surgery. Despite of available therapeutic options for NP, recurrence after polypectomy is found. Vascular endothelial growth factor (VEGF) is a known factor involved in NP. Bevacizumab is a monoclonal antibody, which acts against VEGF. Aim Regarding the availability of bevacizumab and its use in ophthalmic off-label application, in this study, we hypothesized that it could be a choice of non-invasive treatment. The researchers aimed at evaluating the use of bevacizumab in vitro on the growth of NP. Materials and methods In this experimental study, the researchers used eight non-allergic NP tissues from patients admitted for polypectomy clinic of Imam Reza Hospital, Mashhad. Tissues were cultured in DMEM medium based on standard protocols in the presence or absence of bevacizumab (10 to 250 μM) then incubated. The mean of the responses was reported. The level of VEGF and MTT test for NP epithelial cell viability were determined for each group. Data were analyzed using the SPSS software. Results The researchers demonstrated that bevacizumab leads to a decrease in the level of VEGF (the most common cause of angiogenesis in NP) in media culture of NP, dose-dependently (P<0.001). The highest mean was related to the 10-μM group and the least mean was related to the 250-μM group. In MTT test after 5 days, it was shown that the percentage of viable epithelial NP cells (due to apoptosis) was decreased dose-dependently and could lead to resolving NP tissue (P<0.001), significantly. Conclusion This study showed that bevacizumab could help decrease the growth of NP tissue dose-dependently in organ culture in vitro by inhibiting VEGF. It seems that bevacizumab could be a good candidate for the treatment of non-allergic NP.
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Affiliation(s)
- Shadman Nemati
- Rhino-sinus, Ear, and Skull Base Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Faeze Keihanian
- Cardiology Department, Imam Reza & Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Division, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Saeidinia
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Pharmaceutical Research Division, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Bakhshaei
- Faculty of Medicine, Ear, Nose and Throat Department, Mashhad University of Medical Sciences, Mashhad, Iran
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Patel SN, Klufas MA. Evidence to date: ranibizumab and its potential in the treatment of retinopathy of prematurity. Eye Brain 2019; 11:25-35. [PMID: 31693715 PMCID: PMC6711562 DOI: 10.2147/eb.s189684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/25/2019] [Indexed: 12/21/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a leading and preventable cause of childhood blindness worldwide. Although laser photocoagulation remains the gold standard for treatment, the off-label use of anti-vascular endothelial growth factor (anti-VEGF) therapy to treat ROP, particularly posterior zone I disease, is increasing. Although initial studies on anti-VEGF therapy for ROP have focused on bevacizumab, recent studies have proposed that ranibizumab may be a safer and more effective alternative for use in this population. This review updates recent evidence regarding the use of ranibizumab in the management of ROP.
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Affiliation(s)
- Samir N Patel
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael A Klufas
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
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34
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Lu VM, Ravindran K, Graffeo CS, Perry A, Van Gompel JJ, Daniels DJ, Link MJ. Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2: a systematic review and meta-analysis of treatment outcomes. J Neurooncol 2019; 144:239-48. [PMID: 31254266 DOI: 10.1007/s11060-019-03234-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Individual evidence suggests that the anti-angiogenic agent bevacizumab may control vestibular schwannoma (VS) growth and promote hearing preservation in patients with neurofibromatosis type 2 (NF2). However, such metadata has yet to be consolidated, as well as its side-effect profile yet to be fully understood. Our aim was to pool systematically-identified metadata in the literature and substantiate the clinical efficacy and safety of bevacizumab with respect to radiographic tumor response, hearing, and treatment outcomes. METHODS Searches of seven electronic databases from inception to March 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidence of outcomes was then extracted and pooled by random-effects meta-analysis of proportions. RESULTS Eight articles reporting 161 NF2 patients with 196 assessable VS met satisfied all criteria. Radiographic response to bevacizumab was partial regression in 41% (95% CI 31-51%), no change in 47% (95% CI 39-55%), and tumor progression in 7% (95% CI 1-15%). In patients with assessable audiometric data, bevacizumab treatment resulted in hearing improvement in 20% (95% CI 9-33%), stability in 69% (95% CI 51-85%) and additional loss in 6% (95% CI 1-15%) Serious bevacizumab toxicity was observed in 17% (95% CI 10-26%). Subsequent surgical intervention was required in 11% (95% CI 2-20%). CONCLUSIONS Bevacizumab may arrest both tumor progression and hearing loss in select NF2 patients presenting with VS lesions. However, a considerable proportion of patients are anticipated to experience serious adverse events; correspondingly, judicious use of bevacizumab for symptomatic management of VS in NF2 is recommended.
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35
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Nguyen TK, Perry J, Sundaram ANE, Detsky J, Maralani PJ, Calabrese E, Das S, Sahgal A. Rescue bevacizumab following symptomatic pseudoprogression of a tectal glioma post-radiotherapy: a case report and review of the literature. J Neurooncol 2019; 143:475-481. [PMID: 31054097 DOI: 10.1007/s11060-019-03179-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Radiation-induced pseudoprogression is a subacute clinical entity that is distinct from radiation necrosis and mimics tumor progression. Bevacizumab is a well-described treatment option for radiation necrosis, but its role in pseudoprogression is not clearly defined. METHODS We report a case of radiation-induced pseudoprogression rescued with bevacizumab in a 20-year-old man with a biopsy-proven low-grade astrocytoma of the tectum. A review of the literature was also conducted specific to bevacizumab as a treatment for symptomatic pseudoprogression after radiotherapy for CNS tumors. RESULTS This patient was treated with definitive intensity modulated stereotactic radiotherapy at a total dose of 54 Gy delivered in 30 daily fractions. Six weeks after radiotherapy the patient developed progressive headache, weakness and a documented deterioration in vision, which was accompanied by worsening of radiographic findings. A diagnosis of pseudoprogression was made and after limited benefit from a trial of dexamethasone, four cycles of bevacizumab were administered which resulted in rapid clinical and radiographic improvement. CONCLUSIONS Our findings support the potential use of bevacizumab as a rescue agent for symptomatic pseudoprogression.
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Affiliation(s)
- Timothy K Nguyen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, T-Wing 2nd Floor, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - James Perry
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Arun N E Sundaram
- Division of Neuro-Ophthalmology, Department of Ophthalmology & Vision Services, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, T-Wing 2nd Floor, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Pejman J Maralani
- Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Eirena Calabrese
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Division of Neurosurgery, St. Michael'S Hospital, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, T-Wing 2nd Floor, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.
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Gu S, Xue J, Xi Y, Tang R, Jin W, Chen JJ, Zhang X, Shao ZM, Wu J. Evaluating the effect of Avastin on breast cancer angiogenesis using synchrotron radiation. Quant Imaging Med Surg 2019; 9:418-426. [PMID: 31032189 DOI: 10.21037/qims.2019.03.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The visualization of microvasculature is an essential step in understanding the mechanisms underlying early vessel disorders involved in breast cancer and for developing effective therapeutic strategies. However, generating detailed and reproducible data using immunohistochemistry analysis of breast cancer angiogenesis has been difficult. Methods To analyze the diversification of angiogenesis in the development of tumor growth and evaluate the anti-vascular effects of Avastin (bevacizumab), we used new X-ray microangiography and third-generation synchrotron radiation-based micro-computed tomography (SR micro-CT) technology. With these techniques, we were able to investigate the structures and density of microvessels in xenograft mouse models (n=24). Barium sulfate nanoparticles were injected into the left cardiac ventricle of the mice to allow the visualization of blood vessels. Results Three-dimensional structures of microvessels were displayed with a high spatial image resolution of 20-30 µm. The density of angiogenesis and the incidence of lung metastasis were significantly reduced in xenograft mouse models of breast cancer treated with Avastin compared with control groups. Also, the density of smaller vessels (diameter <50 µm) was significantly decreased in the Avastin-treated mice, while the density of larger vessels (diameter >100 µm) was not significantly changed. Conclusions Avastin inhibited tumor growth and lung metastasis by reducing microvessels. Additionally, synchrotron radiation (SR) techniques are useful as an additional tool for more precise quantification of angiogenesis.
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Affiliation(s)
- Shengmei Gu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jingyan Xue
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yan Xi
- School of Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Rongbiao Tang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Wei Jin
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jia-Jian Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xi Zhang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhi-Min Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai 200032, China
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Saoji K, Pathengay A, Chhablani J, Panchal B, Doshi S, Saldanha M. Response to anti-vascular endothelial growth factor of abnormal retinal vascular net in para foveal telangiectasia group II images on optical coherence tomography-angiography. Indian J Ophthalmol 2018; 67:105-108. [PMID: 30574903 PMCID: PMC6324109 DOI: 10.4103/ijo.ijo_374_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To identify optical coherence tomography-angiography (OCT-A) findings to predict treatment response during anti-vascular endothelial growth factor (VEGF) therapy in eyes with para foveal telangiectasia (PFT) group II. Methods: In this retrospective series, Twelve eyes of seven patients diagnosed with PFT group II without evidence of sub-retinal neovascular membrane (SRNVM) clinically or on spectral domain-OCT (SD-OCT) were included. All patients underwent OCT-A on the Topcon DRI OCT Triton® with 4.5 mm macula scans. The patients with abnormal vascular nets were further classified into type A and B nets and administered intravitreal anti-VEGF therapy. Visual acuity and size of type A and B nets were evaluated pre- and post-injection. Paired t-test and intraclass correlation were used to analyse data. Results: Patients with type A net showed significant improvement in visual acuity (logMAR 0.38, P = 0.0047). The size of type A net showed statistically significant decrease (P = 0.0008) on 6 month follow up. Type B net did not show statistically significant difference in visual acuity or size following anti-VEGF therapy. Conclusion: OCT-A plays an important role in early detection of possible neovascular nets (type A), in the absence of obvious SRNVM. Treatment decisions based on OCT-A may be helpful to achieve better visual outcome.
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Affiliation(s)
- Ketan Saoji
- Vitreo-Retinal Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Avinash Pathengay
- Vitreo-Retinal Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Jay Chhablani
- Vitreo-Retinal Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Bhavik Panchal
- Vitreo-Retinal Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Shreyansh Doshi
- Vitreo-Retinal Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Merlin Saldanha
- Vitreo-Retinal Services, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
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Killeen DE, Klesse L, Tolisano AM, Hunter JB, Kutz JW. Long-Term Effects of Bevacizumab on Vestibular Schwannoma Volume in Neurofibromatosis Type 2 Patients. J Neurol Surg B Skull Base 2018; 80:540-546. [PMID: 31534897 DOI: 10.1055/s-0038-1676628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Bevacizumab offers a medical treatment that may slow the growth of vestibular schwannomas (VS) and possibly preserve hearing in patients with neurofibromatosis type 2 (NF2). This study aims to investigate the effect of long-term bevacizumab treatment on VS progression. Methods Demographic, clinical, audiometric, and radiographic data were collected from the medical records of NF2 patients treated with bevacizumab at a tertiary medical center. Results Eleven tumors from seven NF2 patients treated with bevacizumab were analyzed. The median age was 17 years (range: 12-47 years). Median bevacizumab treatment time was 33 months (range: 12-74 months). Of five patients with serviceable hearing pretreatment, one (20%) maintained serviceable hearing during bevacizumab therapy. Significantly slower growth rates for both tumor diameters and tumor volumes were identified during active bevacizumab treatment. Median tumor diameters and volumes during active bevacizumab treatment were 0 cm/year (range: -0.13-0.17 cm/year) and 0.1 cm 3 /year (range: -0.92-0.41), compared with 0.37 cm/year (range: 0-1.5 cm/year, p = 0.0011) and 1.38 cm 3 /year (range: 0.013-3.74), respectively, without bevacizumab treatment ( p = 0.0263). Reduced tumor progression was noted with bevacizumab treatment utilizing both linear greatest diameter (hazard ratio 0.16, p = 0.006) and segmentation volumes (hazard ratio 0.15, p = 0.023). Complications of bevacizumab treatment included fatigue (43%), nausea/vomiting (43%), hypertension (43%), epistaxis (29%), and proteinuria (29%). One subject had a cerebrovascular accident detected on screening magnetic resonance imaging without symptoms or neurological sequelae. Discussion Bevacizumab may reduce tumor growth rate and the risk of progression based on both volumetric and linear measurements.
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Affiliation(s)
- Daniel E Killeen
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Laura Klesse
- Department of Pediatrics and Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Anthony M Tolisano
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jacob B Hunter
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Joe Walter Kutz
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Roohipoor R, Torabi H, Karkhaneh R, Riazi-Eafahani M. Comparison of intravitreal bevacizumab injection and laser photocoagulation for type 1 zone II retinopathy of prematurity. J Curr Ophthalmol 2018; 31:61-65. [PMID: 30899848 PMCID: PMC6407151 DOI: 10.1016/j.joco.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare the efficacy of intravitreal bevacizumab (IVB) injection with conventional laser photocoagulation in eyes with type 1 zone II retinopathy of prematurity (ROP). Methods Preterm infants with type 1 ROP in zone II (stage 2 or 3 ROP with plus disease) were randomly assigned to intravitreal injection of 0.625 mg/0.025 ml bevacizumab (Group 1) or laser photocoagulation (Group 2). Patients were followed weekly for 4 weeks and then biweekly till 90 weeks gestational age. Also, spherical and cylindrical refractive errors were compared at 90 weeks postmenstrual age (PMA). Results A total of 116 preterm infants (232 eyes) were treated and completed the follow-up period. IVB injection was done in 154 eyes (77 cases), and laser photocoagulation was done in 78 eyes (39 cases). ROP regressed after single IVB injection in 149 eyes (96.8%) and in 5 eyes (3.2%) after the second injection. Cataract developed in one eye (0.63%) after IVB injection. ROP regressed in 94.7% of treated eyes (76 eyes) in the laser photocoagulation group; however, retinal fold and traction developed in 2 eyes. Spherical and also cylindrical refractive errors had no significant difference. Conclusions Both IVB injection and laser photocoagulation are effective methods for the treatment of type 1 zone II ROP. However, re-treatment requirement may be higher in the IVB injection group. IVB re-injection is an effective option for re-treatment in persistent cases.
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Affiliation(s)
- Ramak Roohipoor
- Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Torabi
- Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Karkhaneh
- Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Palanisamy K, Nareshkumar RN, Sivagurunathan S, Raman R, Sulochana KN, Chidambaram S. Anti-angiogenic effect of adiponectin in human primary microvascular and macrovascular endothelial cells. Microvasc Res 2018; 122:136-145. [PMID: 30144414 DOI: 10.1016/j.mvr.2018.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/18/2017] [Accepted: 08/22/2018] [Indexed: 12/14/2022]
Abstract
Neovascularization in retina and choroid involves interplay of many cytokines and growth factors. Vascular endothelial growth factor (VEGF) being a pro-angiogenic molecule has been found to be high in aqueous and vitreous humour of patients with proliferative diabetic retinopathy (PDR). VEGF is also found in the fibroblast and retinal pigment epithelial cells (RPE) of choroidal neovascular (CNV) membranes isolated from patients. Though anti-VEGF agents cause regression of clinically visible new vessels, there is evidence that they increase the occurrence of retinal tractional detachment and other adverse effects in PDR and CNV treatments. Adiponectin (APN) is a cytokine, found to be involved in the pathobiology of PDR. It is unclear whether APN plays a reparative or pathological role in the disease condition. In this study, we explored the effect of APN on tube formation in the primary culture of human umbilical vein macrovascular endothelial cells (HUVEC), human retinal microvascular endothelial cells (hREC) and human choroidal endothelial cells (hCEC). Anti-VEGF agent, bevacizumab (avastin) was used as a control. Full-length pAc-APN transfected in HUVEC, hRECs and hCECs inhibited basal tube formation and migration comparable to bevacizumab (Avastin™). In hRECs, full length pAc-APN reduced VEGF or PDR vitreous mediated migration. In a similar way, rAPN significantly disrupted VEGF and PDR vitreous induced tube formation in HUVEC and hREC. Moreover, rAPN significantly reduced VEGF influenced proliferation and phosphorylation of ERK1/2 in hREC. Altogether, our study suggests that APN may be effective in the treatment of retinal neovascularization.
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Affiliation(s)
- Karthikka Palanisamy
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBRIVO, Vision Research Foundation, Chennai, India; School of Chemical and Biotechnology, SASTRA University, Thanjavur, India
| | - Ragavachetty Nagaraj Nareshkumar
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBRIVO, Vision Research Foundation, Chennai, India; School of Chemical and Biotechnology, SASTRA University, Thanjavur, India
| | - Suganya Sivagurunathan
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBRIVO, Vision Research Foundation, Chennai, India; School of Chemical and Biotechnology, SASTRA University, Thanjavur, India
| | - Rajiv Raman
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBRIVO, Vision Research Foundation, Chennai, India
| | | | - Subbulakshmi Chidambaram
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBRIVO, Vision Research Foundation, Chennai, India; Department of Biochemistry and Molecular Biology, Pondicherry University, Puducherry, India.
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Franke AJ, Skelton IV WP, Woody LE, Bregy A, Shah AH, Vakharia K, Komotar RJ. Role of bevacizumab for treatment-refractory meningiomas: A systematic analysis and literature review. Surg Neurol Int 2018; 9:133. [PMID: 30090665 PMCID: PMC6057170 DOI: 10.4103/sni.sni_264_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/22/2018] [Indexed: 01/17/2023] Open
Abstract
Background Meningiomas are the most prevalent primary tumor of the central nervous system (CNS), and although the majority of these neoplasms are classified as benign, nearly one fourth of the lesions display an aggressive profile characterized by pleomorphic histology, high recurrence rates, and overall resistance to standard treatment. Despite the ubiquitous nature of these tumors, no adjuvant therapeutic regimen has been identified which effectively controls disease recurrence and progression after surgery and radiation, leading to a dismal prognosis in this patient population. The primary focus of this research study is, hence, to assess the recently emerging use of bevacizumab, an anti-angiogenic agent, in the treatment of meningiomas. This systematic literature review analyzes the efficacy and safety of therapeutic bevacizumab for treatment-refractory meningiomas. Methods A systematic PubMed search was conducted according to PRISMA guidelines to identify all relevant reports investigating the anti-angiogenic agent bevacizumab in the treatment of intracranial meningiomas. The reported parameters from pertinent retrospective reviews, prospective studies, and case studies were volumetric reduction, radiographic response, clinical stability, overall survival (OS), and progression free survival (PFS) measured at 6 and 12 months postinitiation of treatment. Complications were cataloged based on the range and severity of the therapy-related toxicities. Results A total of 11 articles, 5 retrospective series, 2 prospective trials, and 4 case reports, reporting on a total of 92 patients, were included in this review. The use of bevacizumab therapy for intracranial meningiomas demonstrated median overall PFS of 16.8 months (range: 6.5-22 months) and PFS-6 of 73% (range: 44%-93%). Conclusions Therapeutic bevacizumab, either alone or with combination chemotherapies, for select patient populations with recurrent or progressive meningiomas, offers a treatment option that confers improved overall progression-free survival. To assess OS parameters, larger randomized controlled trials assessing the use of anti-angiogenic agents for recurrent/progressive meningiomas are warranted.
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Affiliation(s)
- Aaron J. Franke
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - William Paul Skelton IV
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | | | - Amade Bregy
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ashish H. Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kunal Vakharia
- Department of Neurological Surgery, University at Buffalo School of Medicine, Buffalo, New York, USA
| | - Ricardo J. Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Faisal SM, Tahir MA, Cheema AM, Anjum MI. Pars plana vitrectomy in vitreous hemorrhage with or without Intravitreal Bevacizumab a comparative overview. Pak J Med Sci 2018; 34:221-225. [PMID: 29643911 PMCID: PMC5857017 DOI: 10.12669/pjms.341.12683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To compare the success in patients having vitreous hemorrhage undergoing pars plana vitrectomy with or without preoperative intravitreal injection of Bevacizumab. Methods: This Randomized controlled trial was conducted at Department of Ophthalmology, Jinnah Postgraduate Medical Centre. Karachi. Duration of study was six months from January 2010 to June 2010. In this study 56 patients of advanced diabetic eye disease were divided into two groups. Patients in Group-A underwent three ports pars plana vitrectomy with preoperative intravitreal injection of Bevacizumab (Avastin) 1.25mg/0.05ml, 3.5mm from the limbus seven days before surgery and in Group-B patients underwent vitrectomy without preoperative intravitreal Bevacizumab (Avastin). Intraoperative bleeding was monitored in both groups and was graded as no bleeding, mild bleeding and severe bleeding. The results were statistically analyzed through computer software SPSS 17. Results: Twenty eight patients in Group-A who were given an injection of intravitreal Bevacizumab (Avastin) before surgery, intraoperative bleeding monitored was, no bleeding in 17 cases (60.7%), mild was observed in 6 cases (21.4%) and severe bleeding requiring diathermy to stop was observed in only 5 cases (17.9%). 28 patients in Group-B that underwent surgery without Avastin no bleeding was observed in only 2 cases (7.1%), mild in 6 cases (21.4%) and severe in 20 cases (71.4%). Conclusions: Intravitreal injection of Bevacizumab (Avastin) was effective before vitrectomy in the surgical management of Advanced Diabetic Eye disease.
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Affiliation(s)
- Syed Muhammad Faisal
- Syed Muhammad Faisal, MBBS, FCPS (Ophth). Consultant Ophthalmologist, Ali Trust Eye Hospital, Karachi, Pakistan
| | - Muhammad Ali Tahir
- Muhammad Ali Tahir, MBBS, FCPS (Ophth), FCPS (Vitreoretina). Consultant Retinal Surgeon, Department of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Alyscia Miriam Cheema
- Alyscia Miriam Cheema, MBBS, FCPS, FRCS. Associate Professor and Head, Department Of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Muhammad Ijaz Anjum
- Muhammad Ijaz Anjum, MBBS, MCPS, FCPS, FRCS. Chief Consultant, Ali Trust Eye Hospital, Karachi, Pakistan
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Koonce NA, Griffin RJ, Dings RPM. Galectin-1 Inhibitor OTX008 Induces Tumor Vessel Normalization and Tumor Growth Inhibition in Human Head and Neck Squamous Cell Carcinoma Models. Int J Mol Sci 2017; 18:ijms18122671. [PMID: 29232825 PMCID: PMC5751273 DOI: 10.3390/ijms18122671] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 12/23/2022] Open
Abstract
Galectin-1 is a hypoxia-regulated protein and a prognostic marker in head and neck squamous cell carcinomas (HNSCC). Here we assessed the ability of non-peptidic galectin-1 inhibitor OTX008 to improve tumor oxygenation levels via tumor vessel normalization as well as tumor growth inhibition in two human HNSCC tumor models, the human laryngeal squamous carcinoma SQ20B and the human epithelial type 2 HEp-2. Tumor-bearing mice were treated with OTX008, Anginex, or Avastin and oxygen levels were determined by fiber-optics and molecular marker pimonidazole binding. Immuno-fluorescence was used to determine vessel normalization status. Continued OTX008 treatment caused a transient reoxygenation in SQ20B tumors peaking on day 14, while a steady increase in tumor oxygenation was observed over 21 days in the HEp-2 model. A >50% decrease in immunohistochemical staining for tumor hypoxia verified the oxygenation data measured using a partial pressure of oxygen (pO2) probe. Additionally, OTX008 induced tumor vessel normalization as tumor pericyte coverage increased by approximately 40% without inducing any toxicity. Moreover, OTX008 inhibited tumor growth as effectively as Anginex and Avastin, except in the HEp-2 model where Avastin was found to suspend tumor growth. Galectin-1 inhibitor OTX008 transiently increased overall tumor oxygenation via vessel normalization to various degrees in both HNSCC models. These findings suggest that targeting galectin-1—e.g., by OTX008—may be an effective approach to treat cancer patients as stand-alone therapy or in combination with other standards of care.
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Affiliation(s)
- Nathan A Koonce
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
- National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Ruud P M Dings
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Abstract
Recently, Lodhi SA and colleagues have reported on a patient with choroidal neovascular membrane (CNVM) associated with tubercular granuloma, who responded to intravitreal bevacizumab injections. The available literature regarding CNVM associated with intraocular tuberculosis is briefly discussed. Choroidal neovascular membrane is a possible complication of choroidal tuberculosis and the patients should be informed about this risk. However, patients usually respond well to intravitreal anti-vascular endothelial growth factor agents as evidenced by the case reported by us and the current case reported by Lodhi et al.
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Affiliation(s)
- Koushik Tripathy
- Department of Vitreoretina and Uvea, ICARE Eye Hospital & Postgraduate Institute, Noida, Uttar Pradesh, India,*To whom correspondence should be addressed: Koushik Tripathy, Department of Vitreoretina and Uvea, ICARE Eye Hospital & Postgraduate Institute, E3A, Sector-26, Noida 201301, Uttar Pradesh, India, Phone: +91-120-2555969, E-mail:
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Sturdza A, Hofmann S, Kranawetter M, Polterauer S, Grimm C, Krainer M, Kirisits C, Pötter R, Reinthaller A, Schwameis R. Increased genitourinary fistula rate after bevacizumab in recurrent cervical cancer patients initially treated with definitive radiochemotherapy and image-guided adaptive brachytherapy. Strahlenther Onkol 2017; 193:1056-1065. [PMID: 28721510 PMCID: PMC5696499 DOI: 10.1007/s00066-017-1178-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/22/2017] [Indexed: 01/15/2023]
Abstract
Background and purpose Patients with recurrent cervical cancer (RecCC) who received definitive radiochemotherapy including image-guided adaptive brachytherapy (IGABT) as primary treatment are currently treated in our institution with palliative intent by chemotherapy (CHT) combined with bevacizumab (BEV). We aim to evaluate the risk of gastrointestinal (GI)/genitourinary (GU) fistula formation in these patients. Materials and methods Data of 35 consecutive patients with RecCC treated initially with radiochemotherapy and IGABT were collected. Known and presumed risk factors associated with fistula formation were evaluated. Fistula rate was compared between patients receiving CHT or CHT+BEV. Results Of the 35 patients, 25 received CHT and 10 patients received CHT+BEV. Clinical characteristics were comparable. Fistulae were reported in 6 patients: two fistulae (8%) in the CHT group, four (40%) in the CHT+BEV group. GU fistula occurred in the CHT+BEV group only (3/4). Of these 6 patients with fistulae, 5 (83%) had undergone previous invasive procedures after the diagnosis of RecCC and 1 patient had undergone pelvic re-irradiation; 3/6 patients had developed a local recurrence. No other risk factors for fistula formation were identified. Conclusion In patients with RecCC after definitive radiochemotherapy including IGABT, the addition of BEV to CHT may increase the risk for GU fistula formation, particularly after invasive pelvic procedures. Future clinical studies are required to identify predictors for fistula formation to subsequently improve patient selection for the addition of BEV in the RecCC setting.
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Affiliation(s)
- Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer CenterVienna, Medical University of Vienna, Vienna, Austria
| | - Sandra Hofmann
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
| | - Marlene Kranawetter
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
| | - Stephan Polterauer
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria.
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria.
| | - Christoph Grimm
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
| | - Michael Krainer
- Clinical Division of Oncology, Department of Medicine 1, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer CenterVienna, Medical University of Vienna, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer CenterVienna, Medical University of Vienna, Vienna, Austria
| | - Alexander Reinthaller
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - Richard Schwameis
- Department of general Gynecology and Gynecologic Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Waehringer Strasse 18-20, Vienna, Austria
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Best SR, Mohr M, Zur KB. Systemic bevacizumab for recurrent respiratory papillomatosis: A national survey. Laryngoscope 2017; 127:2225-2229. [PMID: 28657692 DOI: 10.1002/lary.26662] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/10/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Aggressive laryngeal, tracheal, and pulmonary papilloma is an extremely challenging clinical problem without proven treatment options. A recent German report documented promising results with systemic bevacizumab. The objective of this study is to report the initial experience of this novel treatment in the United States for recurrent respiratory papillomatosis (RRP). STUDY DESIGN Cases series. METHODS Electronic survey of the RRP Task Force of the American Society of Pediatric Otolaryngology, American Broncho-Esophagological Association, and physicians known to the authors to have used systemic bevacizumab for RRP. RESULTS Eleven completed surveys were obtained. In three cases, systemic bevacizumab was considered clinically but not administered. Eight patients were treated with systemic bevacizumab, all for aggressive papillomatosis uncontrolled by surgical and adjuvant therapy, including seven of eight with pulmonary disease. Treatment dosing ranged from 5 to 10 mg/kg every 2 to 4 weeks, with all patients responding (7/8 partial response, 1/8 complete response). In four patients who had postbevacizumab chest imaging, three demonstrated improvement of disease and one stabilization. Treatment interval could be lengthened in seven patients and clinical response maintained. One patient with long-standing pulmonary disease (>10 years) was diagnosed with malignant transformation while on treatment, and bevacizumab was discontinued in lieu of other chemotherapeutic agents. All other patients continue on systemic bevacizumab with minimal complications (hemoptysis n = 1, proteinuria n = 1). CONCLUSIONS Systemic bevacizumab appears to have significant promise in the most treatment-resistant and aggressive forms of papillomatosis with a low complication profile. These results suggest bevacizumab should be studied in a formal clinical trial for RRP. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2225-2229, 2017.
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Affiliation(s)
- Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Michael Mohr
- Department of Medicine, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Karen B Zur
- Pediatric Otolaryngology, The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Levin VA, Chan J, Datta M, Yee JL, Jain RK. Effect of angiotensin system inhibitors on survival in newly diagnosed glioma patients and recurrent glioblastoma patients receiving chemotherapy and/or bevacizumab. J Neurooncol 2017. [PMID: 28631191 DOI: 10.1007/s11060-017-2528-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given prior studies that suggest the use of angiotensin system inhibitors (ASIs) is associated with prolonged overall survival (OS) in glioblastoma (GBM) patients, we evaluated the effect of ASIs in glioma patients receiving chemotherapy and/or bevacizumab (BEV). Using retrospective IRB-approved electronic chart review of newly diagnosed WHO grade 2-4 glioma patients from the Kaiser Permanente Tumor Registry of Northern California, we evaluated the impact of ASIs on OS by Cox proportional hazard model analysis for subgroups who received cytotoxic therapy, cytotoxic therapy with BEV, or BEV alone, as well as those with recurrent GBM (rGBM). Of the 1186 glioma patients who received chemotherapy ASI exposure improved OS (HR 0.82; 95% CI 0.71, 0.93; p = 0.003). When stratified by BEV exposure, a sub-analysis revealed further OS advantage for the BEV group (HR 0.75, 95% CI 0.62, 0.90; p = 0.002). In a second cohort of 181 rGBM patients who received BEV in varying dosages, ASI exposure conferred an OS advantage (HR 0.649; 95% CI 0.46, 0.92; p = 0.016). Moreover, patients with ASI exposure who received low-dose BEV treatment (AUCBEV < 3.6 mg wk/kg) had a significantly longer OS (median = 99 weeks; 95% CI 44.3, 205) than those without ASI (median OS = 55.6 weeks; 95% CI 37.7-73.7; p = 0.032). ASI use is associated with longer OS in glioma patients. Further survival advantage with ASI use was observed in rGBM patients receiving low-dose bevacizumab. These data warrant prospective evaluation of adding ASI to low-dose BEV treatment in GBM patients to improve the outcome of standard therapies.
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Affiliation(s)
- Victor A Levin
- Department of Neurosurgery and Neurosciences, Kaiser Permanente, Redwood City, CA, USA. .,The Universiy of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - James Chan
- Pharmacy Outcomes Research Group, Kaiser Permanente, Oakland, CA, USA
| | - Meenal Datta
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.,Department of Chemical and Biological Engineering, Tufts University, Medford, MA, 02155, USA
| | - Jennie L Yee
- Clinic Administered Medications Drug Use Management, Kaiser Permanente, Oakland, CA, USA
| | - Rakesh K Jain
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
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Diaz RJ, Ali S, Qadir MG, De La Fuente MI, Ivan ME, Komotar RJ. The role of bevacizumab in the treatment of glioblastoma. J Neurooncol. 2017;133:455-467. [PMID: 28527008 DOI: 10.1007/s11060-017-2477-x] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 05/15/2017] [Indexed: 12/25/2022]
Abstract
Bevacizumab has been used in patients with GBM as a salvage therapy since its approval in the United States for recurrent GBM in 2009. In order to review the therapeutic effect of bevacizumab in the primary and recurrent clinical setting we have performed a systematic analysis of data from the published literature. Weighted median progression free survival and overall survival were calculated and compared to standard therapy or other experimental therapies. A qualitative analysis of the limited studies on health related quality of life and effects on steroid requirements was also undertaken. We found that the available literature supports the use of bevacizumab for prolonging PFS and OS in the recurrent setting either alone or in combination with a cytotoxic agent (P < 0.05), but does not support its use in the primary setting (P > 0.05). The survival advantage of bevacizumab compared to experimental therapy at recurrence is limited to 4 months. There is no additional benefit reported to date in health-related quality of life with the use of bevacizumab, although it may reduce steroid requirements. On average there is one side-effect event per patient and 74% of these events are grade 3 toxicity or higher. Further studies investigating the role of bevacizumab in combination with cytotoxic agents at recurrence are awaited.
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Abstract
IMPORTANCE A case of nasal septal perforation secondary to systemic bevacizumab therapy for ovarian cancer is reported. Bevacizumab is a vascular endothelial growth factor A (VEGF-A) inhibitor that is becoming more widely utilized in the oncologic community. There is only one prior report of septal perforation secondary to bevacizumab in the Otolaryngology specific literature. The purpose of this report is: 1) to raise awareness and discuss the literature surrounding the sinonasal complications of bevacizumab and 2) provide workup and treatment recommendations based on the sum of the available literature. OBSERVATIONS We review the clinical record of a 59year old patient who presented with an anterior septal perforation while taking bevacizumab therapy for ovarian cancer. She had mild symptoms. Her oncologist held bevacizumab and topical moisture therapy was started. After several weeks, the perforation remained stable and bevacizumab was restarted for her ovarian cancer. CONCLUSION AND RELEVANCE Bevacizumab is associated with both septal perforation and more widespread sinonasal toxicity. These lesions tend to produce only mild symptoms and can usually be managed conservatively. The decision to hold bevacizumab therapy should be made in conjunction with the patient and medical oncologist. Otolaryngologists should be aware of the toxicity from this increasingly common oncologic therapy.
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Shao Y, Yu Y, Li C, Pei CG, Tu P, Han Y, Gao GP. Clinical observation of the efficacy of Bevacizumab combined with argon green laser in treating fundus macular edema. Exp Ther Med 2017; 13:1480-1484. [PMID: 28413496 PMCID: PMC5377272 DOI: 10.3892/etm.2017.4145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 01/26/2017] [Indexed: 12/03/2022] Open
Abstract
We studied the clinical efficacy of Bevacizumab combined with argon green laser in treating fundus macular edema. From May 2009 to April 2013, 78 patients seeking treatment for macular edema in the First Affiliated Hospital of Nanchang University were enrolled in this study. Patients were randomly divided into two groups: i) The experimental group (n=39) and the control group (n=39). Patients in the experimental group were treated with Bevacizumab (Avastin®) combined with argon green laser, and those in the control group were treated exclusively with argon green laser. Therapeutic effects were compared, and postoperative adverse reactions caused by both treatment methods were compared. Our results showed that, after treatment, the macular foveal thickness was reduced noticeably in both groups, while the therapeutic effect of combined treatment was more prominent. Patients in the experimental group gained the best-corrected visual acuity after one month of treatment, while patients in the control group achieved that after three months of treatment. We concluded that the use of Avastin® combined with argon green laser was safe and effective. Visual acuity was improved obviously with minimum adverse reactions.
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Affiliation(s)
- Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi 330006, P.R. China
| | - Yao Yu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang Key Laboratory of Diabetes, Nanchang, Jiangxi 330009, P.R. China
| | - Cheng Li
- Fujian Province Key Laboratory of Ophthalmology and Vision Research, Eye Institute of Xiamen University, Xiamen, Fujian 361102, P.R. China
| | - Chong-Gang Pei
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi 330006, P.R. China
| | - Ping Tu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang Key Laboratory of Diabetes, Nanchang, Jiangxi 330009, P.R. China
| | - Yun Han
- Fujian Province Key Laboratory of Ophthalmology and Vision Research, Eye Institute of Xiamen University, Xiamen, Fujian 361102, P.R. China
| | - Gui-Ping Gao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi 330006, P.R. China
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