AUTHOR=Li Honghong , Rong Xiaoming , Hu Weihan , Yang Yuhua , Lei Ming , Wen Wenjie , Yue Zongwei , Huang Xiaolong , Chua Melvin L. K. , Li Yi , Cai Jinhua , He Lei , Pan Dong , Cheng Jinping , Pi Yaxuan , Xue Ruiqi , Xu Yongteng , Tang Yamei 

TITLE=Bevacizumab Combined with Corticosteroids Does Not Improve the Clinical Outcome of Nasopharyngeal Carcinoma Patients With Radiation-Induced Brain Necrosis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.746941

DOI=10.3389/fonc.2021.746941

ISSN=2234-943X

ABSTRACT=Objective: To compare the clinical outcome of patients treated with bevacizumab combined with corticosteroids to bevacizumab monotherapy from a radiation-induced brain necrosis (RN) registry cohort (NCT03908502).

Methods: We utilized clinical data from a prospective RN registry cohort (NCT03908502) from Jul. 2017 to Jun. 2020. Patients were considered eligible if they had symptomatic RN after radiotherapy for NPC and received bevacizumab (5mg/kg, 2 to 4 cycles) with a minimum follow-up time of 3 months. The primary outcome was a 2-month response rate determined by MRI and clinical symptoms. Secondary outcomes included quality of life (evaluated by WHOQOL-BREF scale) and cognitive function (evaluated by Montreal Cognitive Assessment scale) at 2-month, RN recurrence during follow-up, and adverse events. 

Results: A total of 123 patients (34 in the combined therapy group and 89 in the monotherapy group) were enrolled in our study with a 0.97 (IQR 0.35-2.60) years median follow-up time. The clinical efficacy of RN did not differ significantly between patients in these two groups (OR 1.642, 95%CI (0.584- 4.614), p=0.347). Furthermore, bevacizumab combined with corticosteroid didn’t reduce the recurrence compared with bevacizumab monotherapy (HR 1.329, 95%CI (0.849-2.079), p=0.213). The most common adverse events of bevacizumab were hypertension (17.89%), followed by nosebleed (8.13%), and fatigue (8.13%). There was no difference in grade 2 or severer adverse events between the two groups (p=0.811). 

Interpretation: Our results showed that the treatment strategy of combining bevacizumab with corticosteroid did not lead to better clinical outcomes for RN patients with a background of radiotherapy for nasopharyngeal carcinoma.