Brain metastases are a major cause of death in patients with advanced lung cancer. Avastin, a drug that interferes with the growth of tumor blood vessels (angiogenesis), is approved to treat both advanced non-small cell lung cancer (NSCLC) and a type of primary malignant brain tumor called glioblastoma. To date, however, there has been little information about the use of Avastin in lung cancer patients with brain metastases. Furthermore, the drug has typically been withheld from these patients due to concerns about bleeding risk.
In a small study published online in the Journal of Neuro-oncology, researchers at Sloan Kettering Cancer Center in New York identified 6 lung cancer patients who had received Avastin for treatment of active brain metastases—5 patients had experienced progressive metastases despite prior treatment for lung cancer, and one patient had received no prior treatment. Avastin was administered alone or combination with various chemotherapy drugs.
MRI scans performed in these patients at least 6 weeks after starting Avastin showed that brain metastases shrank in two patients, and stopped growing completely in three others. One patient experienced continued growth of his brain metastases. Clinical benefit was also observed in the form of improved symptoms and a reduced need for steroids used to treat brain swelling associated with tumors. No recurrent episodes of bleeding in the brain occurred in two patients with a prior history of this complication, nor in three patients on anticoagulant therapy. This study shows that Avastin can be beneficial in patients with brain metastases, even as concerns about bleeding have diminished as more patients with brain tumors have been treated with Avastin.
While Avastin should still be used with caution in patients with brain metastases pending additional clinical studies, these results suggest the drug could be effective for treating for progressive brain metastases from non-small cell lung cancer.