ΠΜΣ Καρκίνος Πνεύμονα: Σύγχρονη Κλινικοεργαστηριακή Προσέγγιση και Έρευνα
Library of the School of Health Sciences

2016-11-23

2016

Maragkos Charilaos

Κωνσταντίνος Ν. Συρίγος καθηγητής ΕΚΠΑ
Άρης Πολύζος καθηγητής ΕΚΠΑ
Κουμάκης Γεώργιος Διευθυντής ΒΠ κλινικής ΑΟΝΑ "ΑΓΙΟΣ ΣΑΒΒΑΣ"

Bevacizumab in fragile patients

Greek

Χορήγηση bevacizumab σε ασθενείς με κακή φυσική κατάσταση και μη μικροκυτταρικό καρκίνο πνεύμονα

Lung cancer is the leading cause of cancer death globally and the non small cell subtype of the disease (NSCLC) accounts for almost 85% of the cases. Among all the molecular pathways implicated in the NSCLC development, neoangiogenesis has a crucial and dynamic role and is basically mediated through the VEGF factor. Bevacizumab is a humanized antibody against VEGF and represents the first antiangiogenetic therapy ever approved for the treatment of the advanced NSCLC. Taking into account that half of the NSCLC patients are older than 65 years old and/or frail (and therefore potentially high risk due to coexistent diseases), is clear that treating them can become difficult despite the established benefits of various chemotherapeutic regimen (including Bevacizumab) in this sensitive subgroups of patients. In this retrospective study we assumed the safety and clinical benefit of Bevacizumab in advanced NSCLC patients with respect to age (> or < 65 years old) and performance status (PS 0-1 vs 2-3). It was found that there was no difference in the frequency of the side effects between these two age groups and the most common toxicity consisted of hemorrhaging events, hypertension, gastrointestinal or cutaneous disorders, proteinuria and dyspnea. No statistically significant were also the differences observed between the two age groups in terms of death risk and disease progression. As far as the performance status of the patients is concerned no discordance regarding the kind and frequency of side effects was observed between the PS 0-1 and PS 2-3 subgroups of patients and again hemorrhaging events, hypertension, gastrointestinal or cutaneous disorders, proteinuria were the most frequent adverse events reported with the exception of dyspnea which was more frequent in the PS 2-3 patients. Death rate was also higher in the PS 2-3 patients but disease progression occurred in higher rates in PS 0-1 patients. Regarding the Bevacizumab maintenance therapy (monotherapy or in combination with Pemetrexed) it was administrated mainly in <70 years old and only to PS 0-1 patients and was correlated with a decline in progression risk of 47% relative to those who received no maintenance therapy. Finally improved overall survival was correlated with history of surgery in early stages of the disease, maintenance therapy and good physical status (PS 0-1). All the above results are consistent with most of the results of subgroup analysis in large clinical trials and show that treatment with Bevacizumab in frail patients with advanced NSCLC is a realistic therapeutic choice and should be administered after careful evaluation of the potential benefits towards toxicity risks.

Lung cancer, bevacizumab, Fragile patients

No

0

Yes

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https://pergamos.lib.uoa.gr/uoa/dl/object/1325258