A pilot study to determine the timing and effect of bevacizumab on vascular normalization of metastatic brain tumors in breast cancer

Abstract

Background: To determine the appropriate time of concomitant chemotherapy administration after antiangiogenic treatment, we investigated the timing and effect of bevacizumab administration on vascular normalization of metastatic brain tumors in breast cancer patients.

Methods: Eight patients who participated in a phase II trial for breast cancer-induced refractory brain metastases were enrolled and subjected to 4 dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) examinations that evaluated Peak, Slope, iAUC 60 , and Ktrans before and after treatment. The treatment comprised bevacizumab on Day 1, etoposide on Days 2-4, and cisplatin on Day 2 in a 21-day cycle for a maximum of 6 cycles. DCE-MRI was performed before treatment and at 1 h, 24 h, and 21 days after bevacizumab administration.

Results: Values of the 4 DCE-MRI parameters reduced after bevacizumab administration. Compared with baseline values, the mean reductions at 1 and 24 h were -12.8 and -24.7 % for Peak, -46.6 and -65.8 % for Slope, -27.9 and -55.5 % for iAUC 60 , and -46.6 and -63.9 % for Ktrans, respectively (all P < .05). The differences in the 1 and 24 h mean reductions were significant (all P < .05) for all the parameters. The generalized estimating equation linear regression analyses of the 4 DCE-MRI parameters revealed that vascular normalization peaked 24 h after bevacizumab administration.

Conclusion: Bevacizumab induced vascular normalization of brain metastases in humans at 1 and 24 h after administration, and the effect was significantly higher at 24 h than at 1 h.

Trial registration: ClinicalTrials.gov, identifier NCT01281696 , registered prospectively on December 24, 2010.

Keywords: Bevacizumab; Breast cancer; Chemotherapy; DCE-MRI.

Fig. 1

A 75-year-old patient with breast cancer with a single brain metastasis had a partial response after 3 BEEP regimen cycles. T1-weighted image (T1WI) and DCE-MRI parameter maps (Peak, Slope, iAUC _60, and Ktrans) of the metastatic tumor in the right frontal lobe at baseline, 1 h, 24 h, and 21 days after the first cycle of BEEP regimen, respectively

Fig. 2

Mean percentage changes of DCE-MRI parameters at 1 h, 24 h, and 21 days compared with baseline values