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Antiangiogéniques et métastases cérébrales: plus de peur que de mal ?

Angiogenesis inhibitors and cerebral metastases: more scary than harmful?

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Oncologie

Abstract

Brain metastases occur in 5% to 20% of cancer patients, depending on the primary tumor type. Several angiogenesis inhibitors have shown clinical efficacy in numerous tumors that frequently metastasize to the brain. However, clinical trials of such angiogenesis inhibitors have excluded patients with brain metastases owing to the theoretical risk of cerebral hemorrhage. Therefore, the available safety data are mainly retrospective: cerebral hemorrhage incidence is estimated to affect 0.1% to 3% of patients treated with angiogenesis inhibitors. Efficacy data are scarce, but case reports of brain metastases with complete and partial responses have been published. Few retrospective reports with few patients suggest that radiation therapy or radiosurgery could be safe. Therefore, available safety data suggest that angiogenesis inhibitor can be used to treat cancer patients with brain metastases. Prospective evaluation is warranted, and cancer patients who harbor brain metastases should not be systematically excluded from prospective clinical trials evaluating angiogenesis inhibitors.

Résumé

Lesmétastases cérébrales (MC) affectent entre 5 et 30 % des patients atteints de cancer en fonction des types tumoraux. Plusieurs molécules à activité antiangiogénique ont montré leur efficacité dans le traitement de tumeurs métastasant fréquemment au cerveau. Cependant, les études de phase III ont exclu le plus souvent les patients atteints de MC à cause du risque théorique d’hémorragie intracérébrale. De ce fait, les seules données d’efficacité et de tolérance disponibles sont rétrospectives: la prévalence des hémorragies intracérébrales sous antiangiogéniques varie selon les études de 0,1 à 3 %; il n’a pas été observé de surrisque hémorragique des antiangiogéniques dans les études contre placebo. Les données d’efficacité sont plus rares, mais des cas de réponses partielles sont décrits. En ce qui concerne l’association avec la radiothérapie encéphalique ou la radiochirurgie, les données rétrospectives sont parcellaires et insuffisantes pour conclure à son innocuité. Ainsi, les données de tolérance et d’efficacité des antiangiogéniques chez les patients atteints de MC plaident pour leur utilisation dans ce contexte. Des données prospectives sont nécessaires et l’existence de MC ne devrait plus être un critère systématique de noninclusion dans les essais.

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Authors and Affiliations

  1. Département de médecine, institut Gustave-Roussy, 114, rue Edouard-Vaillant, F-94805, Villejuif, France

    J. Hadoux & B. Besse

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  1. J. Hadoux
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  2. B. Besse
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Correspondence to J. Hadoux.

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Hadoux, J., Besse, B. Antiangiogéniques et métastases cérébrales: plus de peur que de mal ?. Oncologie 14, 230–236 (2012). https://doi.org/10.1007/s10269-012-2144-y

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  • DOI: https://doi.org/10.1007/s10269-012-2144-y

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