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. 2023 Apr 6;25(4):774-785.
doi: 10.1093/neuonc/noac223.

A nationwide evaluation of bevacizumab-based treatments in pediatric low-grade glioma in the UK: Safety, efficacy, visual morbidity, and outcomes

Katherine Green  1 , Paraskevi Panagopoulou  1 , Felice D'Arco  1 , Patricia O'Hare  1 , Richard Bowman  1 , Bronwen Walters  1 , Christine Dahl  1 , Mette Jorgensen  1 , Pritesh Patel  1 , Olga Slater  1 , Rehana Ahmed  2 , Simon Bailey  3 , Fernando Carceller  4 , Rhiannon Collins  5 , Elizabeth Corley  4 , Martin English  6 , Lisa Howells  7 , Ahmed Kamal  6 , John-Paul Jp Kilday  8   9 , Stephen Lowis  10 , Blanche Lumb  11 , Erika Pace  4 , Susan Picton  7 , Barry Pizer  12 , Ayad Shafiq  3 , Lena Uzunova  11 , Harriet Wayman  8   9 , Shaun Wilson  5 , Darren Hargrave  1 , Enrico Opocher  1   13
Affiliations

A nationwide evaluation of bevacizumab-based treatments in pediatric low-grade glioma in the UK: Safety, efficacy, visual morbidity, and outcomes

Katherine Green et al. Neuro Oncol. .

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.

Keywords: Bevacizumab; low-grade glioma; optic pathway glioma; pediatric; visual outcomes.

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Figures

Figure 1.
Figure 1.
Waterfall plot of MRI (RANO) radiological responses to BBT. ).
Figure 2.
Figure 2.
Kaplan–Meier curves for PFS and visual-EFS with BBT.
Figure 3.
Figure 3.
Visual morbidity per patient at start and end of BBT and at last follow-up (VA morbidity).
Figure 4.
Figure 4.
Waterfall plot of VA changes per eye with BBT.
See this image and copyright information in PMC

References

    1. Packer RJ. Brain tumors in children. Arch Neurol. 1999;56(4):421–425. - PubMed
    1. Youland RS, Khwaja SS, Schomas DA, et al. . Prognostic factors and survival patterns in pediatric low-grade gliomas over 4 decades. J Pediatr Hematol Oncol. 2013;35(3):197–205. - PubMed
    1. Armstrong GT, Conklin HM, Huang S, et al. . Survival and long-term health and cognitive outcomes after low-grade glioma. Neuro Oncol. 2011;13(2):223–234. - PMC - PubMed
    1. Wisoff JH, Sanford RA, Heier LA, et al. . Primary neurosurgery for pediatric low-grade gliomas: a prospective multi-institutional study from the Children’s Oncology Group. Neurosurgery 2011;68(6):1548–54; discussion 1554. discussion 15545. - PubMed
    1. Ajithkumar T, Price S, Horan G, Burke A, Jefferies S. Prevention of radiotherapy-induced neurocognitive dysfunction in survivors of paediatric brain tumours: the potential role of modern imaging and radiotherapy techniques. Lancet Oncol. 2017;18(2):e91–e100. - PubMed