Abstract
SIACI of bevacizumab has emerged as a promising novel therapy in the treatment of recurrent GB. This study assessed the potential of (1)H-MRS as an adjunctive technique in detecting metabolic changes reflective of antiproliferative effects of targeted infusion of bevacizumab in the treatment of GB. Eighteen patients enrolled in a phase I/II study of SIACI of bevacizumab for treatment of recurrent GB were included. Concurrent MR imaging and (1)H-MRS scans were performed before and after treatment. Five distinct morphologic ROIs were evaluated for structural and metabolic changes on MR imaging and (1)H-MRS, which included enhancing, nonenhancing T2 hyperintense signal abnormality, and multiple control regions. Pre- and post-SIACI of bevacizumab peak areas for NAA, tCho, tCr, as well as tCho/tCr and tCho/NAA ratios, were derived for all 5 ROIs and compared using the Wilcoxon signed-rank test. A significant median decrease of 25.99% (range -55.76 to 123.94; P = .006) in tCho/NAA was found post-SIACI of bevacizumab relative to pretreatment values in regions of enhancing disease. A trend-level significant median decrease of 6.45% (range -23.71 to 37.67; P = .06) was noted in tCho/NAA posttreatment in regions of nonenhancing T2-hyperintense signal abnormality. The results of this (1)H-MRS analysis suggest that GB treatment with SIACI of bevacizumab may be associated with a direct antiproliferative effect, as demonstrated by significant reductions of tCho/NAA after the intervention.
Highlights
MethodsEighteen patients enrolled in a phase I/II study of SIACI of bevacizumab for treatment of recurrent GB were included
AND PURPOSE: SIACI of bevacizumab has emerged as a promising novel therapy in the treatment of recurrent GB
Our use of MRS in the present study has demonstrated the potential of the technique, revealing significant and trendlevel significant reductions of tCho/NAA ratios in enhancing and nonenhancing regions of disease, respectively
Summary
Eighteen patients enrolled in a phase I/II study of SIACI of bevacizumab for treatment of recurrent GB were included. The On-line Table provides the patient demographics and characteristics, including age, sex, response/nonresponse status based on RANO criteria,[17] prior IV bevacizumab exposure, prior steroid exposure, IA bevacizumab dose administration, and the number of days from. Inclusion criteria required recurrent World Health Organization grade IV glioblastoma refractory to prior combined radiation treatment and chemotherapy with temozolamide, as well as preand posttreatment standardized gadolinium-enhanced concurrent brain MR imaging and MRS within the timeframe of 1–10 days before and 15–30 days after SIACI of bevacizumab therapy. After 3–5 weeks of observation (range 15–30 days; mean 22 days), patients underwent follow-up brain MR imaging and MRS examinations. No additional therapy was initiated before the post-IA infusion MR imaging/MRS studies were completed
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