Abstract
The association of bevacizumab and irinotecan has been shown to display a quick efficacy in low‐grade glioma (LGG), but most patients relapse within months after cessation of therapy. From October 2012 to March 2014, four patients have been treated with irinotecan–bevacizumab followed by a metronomic maintenance with weekly vinblastine to try to prevent relapses. After a median follow‐up of 23 months after the end of the bevacizumab–irinotecan induction, no patient relapsed. These observations suggest that maintenance chemotherapy with weekly vinblastine after an induction by irinotecan–bevacizumab can improve progression‐free survival in children with LGG.
Highlights
Low-grade glioma (LGG) represents a third of primary central nervous system tumors in children, making it the most common brain tumor in childhood [1]
Previous studies have reported that a treatment with the association of bevacizumab with irinotecan could quickly improve symptoms [3,4,5,6], which is highly relevant in case of visual impairment
We proposed a maintenance protocol with metronomic weekly vinblastine following irinotecan–bevacizumab induction therapy
Summary
Low-grade glioma (LGG) represents a third of primary central nervous system tumors in children, making it the most common brain tumor in childhood [1]. Previous studies have reported that a treatment with the association of bevacizumab with irinotecan could quickly improve symptoms [3,4,5,6], which is highly relevant in case of visual impairment. Most patients relapse within a median of 5 months after treatment cessation [4, 5]. The choice of vinblastine was based on evidence of antitumor activity of Vinca alkaloids in pediatric LGG [7,8,9,10] and their good safety profile. Vinblastine has been demonstrated to be an active drug even when used as a second line or more treatment [9]. Vinblastine does not display auditory toxicity that is associated with carboplatin and which should be avoided in children with visual impairment.
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