A nationwide evaluation of bevacizumab-based treatments in pediatric low-grade glioma in the UK: Safety, efficacy, visual morbidity, and outcomes.
Title | A nationwide evaluation of bevacizumab-based treatments in pediatric low-grade glioma in the UK: Safety, efficacy, visual morbidity, and outcomes. |
Publication Type | Journal Article |
Year of Publication | 2023 |
Authors | Green, K., Panagopoulou P., D'Arco F., O'Hare P., Bowman R., Walters B., Dahl C., Jorgensen M., Patel P., Slater O., Ahmed R., Bailey S., Carceller F., Collins R., Corley E., English M., Howells L., Kamal A., Kilday J-P. Jp, Lowis S., Lumb B., Pace E., Picton S., Pizer B., Shafiq A., Uzunova L., Wayman H., Wilson S., Hargrave D., & Opocher E. |
Journal | Neuro Oncol |
Volume | 25 |
Issue | 4 |
Pagination | 774-785 |
Date Published | 2023 Apr 06 |
ISSN | 1523-5866 |
Keywords | Bevacizumab, Child, Humans, Irinotecan, Optic Nerve Glioma, United Kingdom, Visual Acuity |
Abstract | BACKGROUND: Bevacizumab is increasingly used in children with pediatric low-grade glioma (PLGG) despite limited evidence. A nationwide UK service evaluation was conducted to provide larger cohort "real life" safety and efficacy data including functional visual outcomes.
METHODS: Children receiving bevacizumab-based treatments (BBT) for PLGG (2009-2020) from 11 centers were included. Standardized neuro-radiological (RANO-LGG) and visual (logMAR visual acuity) criteria were used to assess clinical-radiological correlation, survival outcomes and multivariate prognostic analysis.
RESULTS: Eighty-eight children with PLGG received BBT either as 3rd line with irinotecan (85%) or alongside 1st/2nd line chemotherapies (15%). Toxicity was limited and minimal. Partial response (PR, 40%), stable disease (SD, 49%), and progressive disease (PD, 11%) were seen during BBT. However, 65% progressed at 8 months (median) from BBT cessation, leading to a radiology-based 3 yr-progression-free survival (PFS) of 29%. Diencephalic syndrome (P = .03) was associated with adverse PFS. Pre-existing visual morbidity included unilateral (25%) or bilateral (11%) blindness. Improvement (29%) or stabilization (49%) of visual acuity was achieved, more often in patients' best eyes. Vision deteriorated during BBT in 14 (22%), with 3-year visual-PFS of 53%; more often in patients' worst eyes. A superior visual outcome (P = .023) was seen in neurofibromatosis type 1-associated optic pathway glioma (OPG). Concordance between visual and radiological responses was 36%; optimized to 48% using only best eye responses.
CONCLUSIONS: BBTs provide effective short-term PLGG control and delay further progression, with a better sustained visual (best > worst eye) than radiological response. Further research could optimize the role of BBT toward a potentially sight-saving strategy in OPG.
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DOI | 10.1093/neuonc/noac223 |
Alternate Journal | Neuro Oncol |
PubMed ID | 36239316 |
PubMed Central ID | PMC10076941 |