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    Pheeboky1 started following

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  • Pheeboky1's Avatar

    Pheeboky1 asked a questionBrain and Spinal Cord Tumors in Adults

    What are anyone's experiences with talking avastin for brain swelling?

    • SueRae1's Avatar
      SueRae1

      I was on Avastin for 7 months last year to treat both my kidney and breast cancers, so I can give what side effects I experienced with the drug, but not for your particular treatment.

      Avastin raised my BP, which we were able to control with meds, until the very end, when my Cardiologist decided I had 'acceptable high BP" - it was 158/90 - down from 195/110. I've been off the drug since Dec, and it took until May for my BP to come down enough to cut my meds. My last reading was 110/72 on about 1/4 of the medication I was on previously.
      High BP is a known side effect of the drug.

      One issue that I have, is that high BP runs in my family, and I have been on meds (very low dose before chemo) for the last 17 years. So you may not experience such high BP

      I'm sure your oncologist has weight the risks and benefits of using Avastin and decided that the benefits outweighed the risks. I do know that there have been very good out comes from the use of the drug.

      over 3 years ago
    • carm's Avatar
      carm

      Pheeboky1,
      I have never heard of using Avastin to reduce swelling in the brain. It is a targeted therapy that blocks angiogenesis so I really can't see the correlation in your post. I would assume you are on Decadron as most AAAs are, and I would think that it is the steroid that keeps the swelling down. I have read of using Avastin for Astrocytomas and GBMs and it shows great promise. Good luck to you. I hope you see the benefit of the drug, it is a great biologic that has shown to be very beneficial in many malignancies. Take care, Carm RN.

      over 3 years ago
    • GregP_WN's Avatar
      GregP_WN

      I searched the term "avastin" in our experiences tab and got these results. You might look through them to see if you find some more information while waiting for others to answer.
      https://www.whatnext.com/search/experiences?utf8=%E2%9C%93&search%5Bquery%5D=avastin&commit=Search

      over 3 years ago
  • Pheeboky1's Avatar

    Pheeboky1 asked a questionBrain and Spinal Cord Tumors in Adults

    How well does avastin help with brain swelling from astrocytoma?

    • carm's Avatar
      carm

      Pheeboky1,
      Funny you should ask. I received this just today from Practice Update. How it will affect swelling is not addressed and knowing the mechanism of the drug, it might not when compared to a steroid, but the drug does show promise. Best of luck, Carm RN.

      Frontline Bevacizumab Fails to Boost Glioblastoma Survival in Key Trials

      IMNG Medical Media, 2013 Jun 03 , N Osterweil

      

      CHICAGO (IMNG) – Adding bevacizumab to frontline radiation and temozolomide therapy for glioblastoma produced disappointing results in a double-blind, placebo-controlled phase III trial.

      Bevacizumab (Avastin) extended progression-free survival, but did not improve overall survival in the Radiation Therapy Oncology Group (RTOG) 0825 study, and investigators reported that the angiogenesis inhibitor was associated with worse neurocognitve and quality of life outcomes.

      Among 637 patients who were randomized, median overall survival reached 16.1 months in those assigned to radiation, temozolomide (Temodar), and placebo, compared with 15.7 months in patients assigned to radiation, temozolomide, and bevacizumab, Dr. Mark R. Gilbert reported in the plenary session at the annual meeting of the American Society of Clinical Oncology.

      Median progression-free survival reached 10.7 months in the bevacizumab arm, vs. 7.3 months in the placebo arm, said Dr. Gilbert, professor of neuro-oncology at the University of Texas M.D. Anderson Cancer Center in Houston. The P value was .0007, but this difference was not statistically significant because of an unusual trial design that split criteria for statistical significance between the two primary outcome measures of overall and progression-free survival. In addition, patients in the bevacizumab arm had significantly worse neurocognitive and overall symptom scores over time.

      “We feel that bevacizumab remains an important therapy for our patients with glioblastoma, but the results of this study do not support its frontline use. Rather, it can be reserved as a later treatment,” he said at a press briefing prior to his presentation.



      Outcomes contrast with Avaglio study

      Some results of the publicly funded RTOG 0825 trial run counter to those from the Avaglio study, an industry-sponsored trial whose results were also presented at the ASCO annual meeting.

      The Avaglio investigators found that adding bevacizumab to radiotherapy and temozolomide “achieved a clinically meaningful, statistically significant progression-free survival improvement in patients with glioblastoma,” Dr. Warren Mason, a neuro-oncologist at the Princess Margaret Hospital in Toronto, reported at another session.

      The Avaglio trial, which ran parallel to RTOG 0825 and was very similar in design, showed a quality of life benefit for patients on bevacizumab, but did not look at neurocognitive outcomes.

      Median progression-free survival in Avaglio reached 10.6 months in 458 patients in its radiation, temozolomide, and bevacizumab arm, vs. 6.2 months in 463 patients in its radiation, temozolomide, and placebo arm, and the difference was significant (hazard ratio, 0.64; P less than .0001).

      However, as in RTOG 0825, median overall survival was virtually identical in both Avaglio trial arms, at 16.8 and 16.7 months, respectively.



      Bevacizumab misses RTOG targets

      The RTOG trial enrolled neurologically stable patients with glioblastoma who had a Karnofsky performance score of at least 70 and who had tumor tissue samples available for evaluation. They were randomized to receive standard chemoradiation with temozolomide for 3 weeks followed by chemoradiation with temozolomide and either bevacizumab or placebo for 6-12 maintenance cycles.

      The treatment type was unblinded at progression, and patients were allowed to cross over, or continue on, bevacizumab. Progression was defined as a greater than 25% increase in tumor area without recent steroid reduction, or worsening of neurologic symptoms.

      In a pooled analysis including both study arms, patients with methylation of the DNA repair enzyme O6-methylguanine-DNA methyltransferase (MGMT) had better median and overall survival than patients with MGMT unmethylated (methylated MGMT is a marker for favorable prognosis). Median overall survival for the MGMT methylated group was 23.2 months, compared with 14.3 months for the unmethylated group (HR in unmethylated tumors, 2.10; P less than .001). Respective median progression-free survival was 14.1 months vs. 8.2 months (HR, 1.67; P less than .001).

      (The results of the GLARIUS trial, also reported at this meeting, showed that bevacizumab combined with irinotecan (Camptosar) in chemoradiation was associated with longer progression-free survival than temozolomide chemoradiation in newly diagnosed patients with MGMT-unmethylated glioblastoma. In a preliminary finding from that study, there was a suggestion of an overall survival benefit for the bevacizumab-irinotecan combination.)

      As noted, in RTOG 0825, patients in the bevacizumab arm scored significantly worse on a clinical trial battery composite of cognitive function (P = .038), on overall symptom interference with daily activity (P less than .001), and on quality of life cognitive function (P less than .009).

      In contrast, patients on bevacizumab in Avaglio had improved quality of life, prolonged preservation of performance scores, and reduced steroid doses compared with controls.



      Why the differences?

      Dr. Howard A. Fine, director of the brain tumor center at New York University, the invited discussant for RTOG 0825, said that the differences in patient-reported outcomes between the trials may reflect differences in statistical analysis, possibly different analytical methodologies used to query the data, or the lack of neurocognitive data in Avaglio.

      Another possibility to account for the worsening neurocognitive function with bevacizumab is the drug’s documented ability to stabilize the blood-brain barrier and decrease MRI gadolinium enhancement, he said. This could mean that patients experience radiographic occult disease progression that does not show up well on brain scans.

      Dr. Gilbert and Dr. Fine commented that theoretically at least, glioblastoma should be an ideal target for angiogenesis inhibitors such as bevacizumab, because they display a high degree of vascularity, and endothelial proliferation is part of the pathologic definition of the disease.

      But although bevacizumab has been demonstrated to improve response rates and delay progression in recurrent glioblastoma, its relative lack of efficacy in the first line is puzzling, Dr. Fine said.

      Potential explanations include the crossover designs of both the RTOG and Avaglio studies, suboptimal delivery of bevacizumab to the tumor, or the possibility that the vascular endothelial growth factor receptor may not be the best target in glioblastoma.

      “Despite these new data demonstrating its limitation, I feel very strongly that bevacizumab represents the single most important agent in glioblastoma since temozolomide, and maybe even more so. Ongoing and future trials will better define how and when it should be optimally used in these patients that have such limited therapeutic options,” Dr. Fine concluded.

      The RTOG 0285 study was supported by the National Cancer Institute, with additional support from Genentech. Avaglio was supported by Roche. Dr. Gilbert disclosed consulting for, and receiving honoraria and research support from, Genentech. Dr. Mason disclosed being a consultant/adviser to Hoffman-La Roche. Dr. Fine reported having no relevant financial disclosures.

      over 3 years ago
    • blackcamaros' Avatar
      blackcamaros

      I was put on Avastin for exactly that reason. I had just started the Temodar maintenance, and had an MRI , which showed new tumor growth, and severe swelling again. I was scheduled for an emergency Avastin infusion . , That infusion started on a two week infusion schedule, which is now an infusion every three weeks.

      AFter the emergency infusion, I asked the oncologist how we knew the Avastin was working. His reply, " because if it wasn't working, you would be in a coma." after the emergency nfusion he told me to get my things in order, and to be around friends and family, so we had an open house that weekend. All this started in August of 2012, and I am still getting my infusions every
      3 weeks.

      Best of luck PHeebok1

      over 3 years ago
  • Pheeboky1's Avatar

    Pheeboky1 asked a questionBrain and Spinal Cord Tumors in Adults

    My husband is currently being weaned off of steroids after 3 months. Won't that cause swelling again.?

    4 answers
    • LuckyDogs' Avatar
      LuckyDogs

      My experience was the swelling was the result of my surgery, not of chemo therapy or radiation treatments. The steroid was definitely the worst part of the whole experience. Taper very gradually over an extended time. I experienced numerous side effects from trying to taper too quickly for what my body was ready for. Good luck.

      almost 4 years ago
    • melee_me's Avatar
      melee_me

      Steroids in brain tumor treatment are important, but it is equally important to gradually reduce amount and stop when docs say it is no longer needed. This is because they can have lots of side effects with long term use. More info http://www.cancerresearchuk.org/cancer-help/type/brain-tumour/treatment/steroid-treatment-for-brain-tumours

      almost 4 years ago
    • K2P's Avatar
      K2P

      We were told that radiation can cause mild swelling in the tissue around the tumor. There are benchmark dates post treatment that swelling can occur. This swelling is usually is mild and does not need steroid treatment unless it causes side effects. Most often people can get off the steroids either during or shortly after treatment. My son had 'no room' for swelling and as a result was on steroid treatment for a year. They are a necessary evil, and getting off of them as soon as possible should be the goal. If there is a need to re-start them in the future, they will just up the dosing. Hope that helps. Getting off of long-term steroids is a roller coaster ride :( Hoping for things to improve for you every day!

      almost 4 years ago
  • Pheeboky1's Avatar

    Pheeboky1 asked a questionBrain and Spinal Cord Tumors in Adults

    Driving

    5 answers
    • queen3rjd's Avatar
      queen3rjd

      My husband had 4 tumors on the left side of the brain and our Radoligist would not allow him to drive for three months. I was really glad not only for his safety but for all other drivers.

      almost 4 years ago
    • creed0608's Avatar
      creed0608

      My husband had a grade 3 oligoastrocytoma removed on the left side. When he was diagnosed, he was not allowed to drive. But 2 weeks after surgery after full removal and on anti seizure medications, he was given the ok to drive. That was 2 years ago and he has not had any issues. Good luck to you and your husband,

      almost 4 years ago
    • melee_me's Avatar
      melee_me

      after my daughter recovered from her surgery, radiation & chemo for Grade IV Glioblastoma, she took driving lessons and got her licence. She's had no problems driving in the 4 yrs since then.

      almost 4 years ago
  • Pheeboky1's Avatar

    Pheeboky1 asked a questionBrain and Spinal Cord Tumors in Adults

    Support groups

    4 answers