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Bevacizumab in Combination with Chemotherapy for Colorectal Brain Metastasis

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Abstract

Background

Brain metastases are rare in patients with colorectal cancer, but the incidence is expected to rise due to prolonged survival resulting from more effective regimens including anti-EGF-receptor and anti-angiogenic antibodies. Because of the potential fear of intracranial hemorrhage, patients with colorectal brain metastases have been excluded from clinical trials involving bevacizumab or aflibercept.

Patients

Five patients with colorectal brain metastases treated with bevacizumab-containing chemotherapy regimen following either neurosurgery, radiosurgery, or whole-brain radiotherapy were identified between 2009 and 2014. The clinicopathological data and outcomes for these patients were reviewed.

Results

Mean time to disease progression concerning brain metastases was 14.8 months (range 5–25). Overall survival was 26.2 months (range 7–42 months) and overall survival since diagnosis of brain metastases was 20.6 month (7–42). Best response was a partial response in two and a stable disease in three patients. Treatment-related adverse events were mild hypertension (grade 1), diarrhea (grade 1), and fatigue (grade 1). No intracranial hemorrhage was observed.

Conclusion

Bevacizumab in combination with chemotherapy is a feasible option for palliative treatment of patients with colorectal brain metastasis with a good safety profile.

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Abbreviations

CRC:

Colorectal cancer

OS:

Overall survival

CRP:

C-reactive protein

EGF:

Epidermal growth factor

FDA:

Food and Drug Administration

VEGF:

Vascular endothelial growth factor

CT:

Computed tomography

NSCLC:

Non-small cell lung cancer

MRI:

Magnetic resonance imaging

CTCAE:

Common terminology criteria for adverse events

CNS:

Central nervous system

ITT:

Intention to treat

RCT:

Randomized control trial

ICH:

Intracerebral hemorrhage

WBRT:

Whole-brain radiotherapy

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Authors and Affiliations

  1. Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany

    Fabian Finkelmeier, Oliver Waidmann, Stefan Zeuzem & Jörg Trojan

  2. Institut für Neuroradiologie, Universitätsklinikum Frankfurt, Goethe-Universität, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany

    Se-Jong You

  3. Gamma Knife Zentrum Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany

    Robert Wolff

  4. Dr. Senckenbergisches Institut für Neuroonkologie, Universitätsklinikum Frankfurt, Goethe-Universität, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany

    Oliver Bähr

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  1. Fabian Finkelmeier
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Correspondence to Fabian Finkelmeier.

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Conflict of Interest

O. Waidmann received a travel grant from Roche, and O. Bähr received consulting fees and travel grants from Roche. S. Zeuzem and J. Trojan received consulting fees from Roche.

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Finkelmeier, F., You, SJ., Waidmann, O. et al. Bevacizumab in Combination with Chemotherapy for Colorectal Brain Metastasis. J Gastrointest Canc 47, 82–88 (2016). https://doi.org/10.1007/s12029-015-9795-z

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