Avastin

At the 2013 Annual Meeting of the American Society of Clinical Oncology, researchers reported important progress in brain tumor treatment:

Bevacizumab for Treating Newly Diagnosed Brain Cancer

Two recent studies showed that adding bevacizumab (Avastin) to standard treatment (radiation and then temozolomide [Temodar and others]) does not appear to help people with newly diagnosed brain cancer live longer. However, according to another clinical trial, the combination of bevacizumab and irinotecan (Camptosar and others) may be a promising treatment option for those who have a more aggressive type of brain cancer called MGMT-unmethylated glioblastoma.

The two clinical trials—known as the RTOG 0825 and AVAglio studies—included nearly 1,400 people with newly diagnosed brain cancer. Half of the patients received standard treatment plus bevacizumab, while the others received standard treatment alone. In both studies, there was no real survival difference between the groups treated with bevacizumab and those that were not. In RTOG 0825, the patients in both groups survived between about 15 and 16 months. In the AVAglio study, the patients in both groups survived about 17 months. However, in the AVAglio study, researchers reported that it did take longer for the tumor to grow in those who received bevacizumab than in those who did not (10.6 months versus 6.2 months).

The third study (the German GLARIUS trial) included more than 180 people with MGMT-unmethylated brain cancer. All of these patients received radiation. In addition, half of them received bevacizumab and irinotecan, and the others received temozolomide. The combination of bevacizumab and irinotecan seemed to be better than temozolomide in delaying the growth of cancer. The cancer did not continue to grow in about 80 percent of the patients on bevacizumab and irinotecan, compared with about 40 percent of those on temozolomide. Bevacizumab is a targeted treatment that helps block the development of blood vessels in brain tumors. (Targeted treatments are designed to spare healthy tissues and tend to cause less severe side effects than chemotherapy.) This is an important part of treating brain tumors because they develop strong networks of blood vessels that feed their growth.

What Patients Need to Know

Bevacizumab has been approved by the U.S. Food and Drug Administration to treat people with brain tumors that continue growing after standard treatment. Researchers wanted to find out whether bevacizumab might also be an effective way to treat newly diagnosed brain tumors. It seems that the standard treatment of radiation and temozolomide is still the most effective way to treat people with these tumors.

However, there may be a place for bevacizumab in the treatment of the more aggressive MGMT-unmethylated brain cancer. This type of tumor usually does not respond well to standard treatment with temozolomide. Further studies are needed to confirm these early results with bevacizumab and irinotecan for this group of people. Then, doctors should have a better idea of how best to use bevacizumab in combination treatment to help people with brain cancer.

Donepezil to Improve Memory Function for People With Brain Cancer

Donepezil (Aricept and others) may offer some improvement in memory and motor function (the ability to move muscles precisely). This medication has been used to treat the symptoms of Alzheimer’s disease, such as memory loss and mental confusion. According to a recent study, donepezil benefited certain people who have received radiation for brain cancer. However, the improvement in memory was seen only in those who had more mental symptoms than other patients before the start of the study.

Nearly 200 people who had received radiation for brain cancer took part in this clinical trial. Half of them were given donepezil daily, and the others were given a placebo (a look-alike pill with no active ingredient). Six months later, those who took donepezil and had more mental symptoms at the start of treatment experienced improvement in verbal memory. In this smaller group of people who received donepezil, motor function also seemed to be better. However, for the rest of the patients in the study, there were no major differences in mental or motor function between those who received donepezil and those who did not.

What Patients Need to Know

Studies have shown that more than half of people who receive radiation for brain tumors may experience some difficulty with memory and paying attention. According to the results of this recent study, donepezil may offer small benefits to certain people with brain cancer who have had radiation. Researchers may study donepezil further in a larger group of people with brain cancer to see whether it can improve some of the side effects associated with radiation treatment.