标准治疗方案中加入阿瓦斯汀可显著延长初诊侵袭性胶质瘤的无进展生存期(AVAglio研究)

2012-11-26 MedSci 网络

在现行标准治疗方案中增加阿瓦斯汀,可显著延长新诊断的侵袭性脑癌(多形性胶质母细胞瘤,GBM)患者无进展生存期4.4个月(无进展生存期为10.6个月VS 放疗和化疗加安慰剂治疗组的6.2个月,HR=0.64,p<0.0001),疾病进展风险值降低36%。这些数据(来源于评价阿瓦斯汀联合标准治疗(放射和替莫唑胺的化疗)的III期临床试验AVAglio),在华盛顿举办的神经肿瘤学会年会上首次公布。

在现行标准治疗方案中增加阿瓦斯汀,可显著延长新诊断的侵袭性脑癌(多形性胶质母细胞瘤,GBM)患者无进展生存期4.4个月(无进展生存期为10.6个月VS 放疗和化疗加安慰剂治疗组的6.2个月,HR=0.64,p<0.0001),疾病进展风险值降低36%。这些数据(来源于评价阿瓦斯汀联合标准治疗(放射和替莫唑胺的化疗)的III期临床试验AVAglio),在华盛顿举办的神经肿瘤学会年会上首次公布。

AVAglio试验研究也显示,与标准治疗相比,增加阿瓦斯汀到标准治疗方案中,能保证健康相关的生活质量,包括维持功能性自立。而且,那些使用阿瓦斯汀治疗的患者比应用标准治疗的患者所需皮质类固醇更少。由于GBM的症状的影响波及患者及其家人和监护人,因此,在这种疾病治疗中,通过症状处理来维持生活质量是一种关键性的目标。

KirstenHopkins(临床肿瘤学顾问医生,英国八个试验中心之一的布里斯托尔血液学和肿瘤学中心AVAglio试验的研究者)评论这些结果说,“胶质母细胞瘤是一种具有破坏性和侵袭性的脑癌。它的症状(包括影响言语、运动功能和行为)使患者及其家人痛苦,并对生活质量产生负面影响。而且,当疾病发展时,患者经常快速恶化,因此,延缓这个疾病(有效延长在第一次诊断和疾病进展之间的时间)是肿瘤科医生的一个关键目标,即确保患者尽可能长的维持其优质的生活质量。

GBM是最常见的、最具侵袭性的恶性脑肿瘤,每年在英国诊断的4500名主要的脑肿瘤患者中超过半数(是GBM)。只有有限的治疗选择,因而预后极差。多数患者在诊断后生存期少于2年,平均生存期一般少于1年,AVAglio的研究发现向新诊断的GBM患者的治疗迈出了重要的一步。

阿瓦斯汀当前没有被许可用于治疗新诊断的GBM。基于AVAglio研究的结果,罗氏将向监管当局提交其许可申请。AVAglio的全部数据(最终总生存期(OS),其他的复合首要指标的终点)有望在2013年完成。

AVAglio试验中,阿瓦斯汀的不良反应一般是可控的,没有观察到新的安全性问题。阿瓦斯汀有较好的耐受性,在治疗GBM临床试验中,最经常观察到的不良反应是高血压,静脉瘘,伤口愈合并发症,蛋白尿,动脉和静脉血栓栓塞,出血和充血性心脏衰竭。

关于AVAglio研究

AVAglio是一项随机、双盲、安慰剂对照、多中心III期临床试验,旨在评价阿瓦斯汀联合放疗和替莫唑胺化疗,随后手术或活检,对新诊断的多形性胶质母细胞瘤(GBM)患者治疗的有效性和安全性。病人被随机分配到任意一组:

阿瓦斯汀加放疗和替莫唑胺化疗治疗6周,随后停止4周。然后,患者接受阿瓦斯和替莫唑胺治疗6个疗程,而后仅用阿瓦斯汀治疗直到疾病恶化,或者

放疗、替莫唑胺和安慰剂治疗6周,随后停止4周。然后患者接受替莫唑胺和安慰剂治疗6个疗程,而后仅用安慰剂治疗直到疾病恶化。

这项研究的复合首要指标结点是试验研究者评价的OS(总生存期)和PFS(无进展生存期)。次要指标结点包括1年和2年存活率、一个独立顾问委员会评估的PFS、安全性和生活质量。总共921名患者的治疗是这项试验的一部分。

原始来源:

Chinot OL, de La Motte Rouge T, Moore N, Zeaiter A, Das A, Phillips H, Modrusan Z, Cloughesy T.AVAglio: Phase 3 trial of bevacizumab plus temozolomide and radiotherapy in newly diagnosed glioblastoma multiforme.Adv Ther. 2011 Apr;28(4):334-40.

关于阿瓦斯汀

阿瓦斯汀被欧盟批准用于五种常见的癌症晚期治疗:结直肠癌,乳腺癌,肺癌,肾癌和卵巢癌。到目前为止,已有超过1300万患者使用了阿瓦斯汀。请参阅阿瓦斯产品特征概要的详细信息,可在此处(查看):http://www.emc.medicines.org.uk

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    2012-11-28 sunyl07
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