Patients with solid tumor brain metastases that progress after whole-brain radiation have limited options. This prospective trial investigated the efficacy, safety, and tolerability of bevacizumab as salvage therapy in this population. Eligible patients received bevacizumab 10 mg/kg intravenously every 2 weeks until progression. The primary endpoint was radiologic response using Response Assessment in Neuro-Oncology (RANO) criteria. The secondary endpoints were progression-free survival (PFS), overall survival (OS), duration of response, and safety. Quality of life (QOL) was studied using the Functional Assessment of Cancer Therapy-Brain (FACT-Br) scale. Twenty-seven patients were enrolled, with twenty-four having evaluable data for response. The majority of histologies (n = 21, 78%) were breast cancer. The remaining histologies were non-small-cell lung cancer (n = 4, 15%), neuroendocrine cancer (n = 1, 3%), and papillary fallopian serous adenocarcinoma (n = 1, 3%). Eighteen patients had radiologic response, with two patients demonstrating partial response (8.33%) and sixteen patients demonstrating stable disease (66.7%). The median duration of response was 203 days. PFS at 6 months was 46%, median PFS was 5.3 m, and median OS was 9.5 m. Treatment was well tolerated, with six patients experiencing grade 3 lymphopenia and hypertension. There was one grade 3 thromboembolism. QOL was not negatively impacted. Bevacizumab is a safe and feasible salvage treatment with durable response and favorable overall survival for patients with progressive brain metastases after whole-brain radiation.
实体瘤脑转移患者在全脑放疗后若病情进展，治疗选择有限。本前瞻性研究旨在评估贝伐珠单抗作为挽救性疗法在该人群中的疗效、安全性及耐受性。符合条件患者每两周静脉输注贝伐珠单抗10 mg/kg直至疾病进展。主要终点为采用神经肿瘤疗效评估标准（RANO）评估的影像学缓解率，次要终点包括无进展生存期、总生存期、缓解持续时间及安全性。采用癌症治疗功能评估-脑肿瘤量表评估生活质量。共入组27例患者，其中24例具有可评估疗效数据。组织学类型以乳腺癌为主（21例，78%），其余为非小细胞肺癌（4例，15%）、神经内分泌癌（1例，3%）及输卵管浆液性乳头状腺癌（1例，3%）。影像学缓解患者18例，其中部分缓解2例（8.33%），疾病稳定16例（66.7%）。中位缓解持续时间为203天。6个月无进展生存率为46%，中位无进展生存期5.3个月，中位总生存期9.5个月。治疗耐受性良好，6例患者出现3级淋巴细胞减少及高血压，1例发生3级血栓栓塞事件。生活质量未受负面影响。贝伐珠单抗作为全脑放疗后进展性脑转移患者的挽救治疗方案安全可行，可产生持续缓解并带来良好总生存获益。
肿瘤(癌症)患者之家