Quality of life, vascular endothelial growth factor inhibition, and survival outcomes with combination oral metronomic therapy in platinum refractory epithelial ovarian carcinoma: Results from a randomized study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6048-6048
Author(s):  
Aparna Sharma ◽  
Sachin Khurana ◽  
Prabhat Singh Malik ◽  
Mayank Singh ◽  
Sandeep Mathur ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Histopathological Diagnosis ◽  
Vascular Endothelial ◽  
Patient Reported ◽  
Platinum Refractory ◽  
Metronomic Therapy ◽  
Endothelial Growth Factor

6048 Background: Patients with recurrent and refractory epithelial ovarian cancer (EOC) have dismal outcomes. We evaluated a combination of oral metronomic therapy in platinum refractory EOC vis-à-vis angiogenic marker expression and its impact on patient reported outcomes. Methods: Between October 2017 and September 2019, 75 patients were randomized to receive etoposide (VP-16) (50 mg daily for 14 days) cyclophosphamide (50 mg daily for 28 days) (Arm A, n = 38) or etoposide (VP-16) (50 mg daily for 14 days) cyclophosphamide (50 mg daily for 28 days) and pazopanib (400 mg daily 28 days) every 28 days (Arm B, n = 37). Eligibility criteria included histopathological diagnosis of EOC, platinum refractory disease and ECOG performance status 0-2. Primary endpoint was serological progression free survival (PFS) as defined by Rustin criteria. Quality of Life (QoL) (evaluated using the EORTC QLQC30 and OV 28 questionnaires) and serum vascular endothelial growth factor (VEGF) were ascertained at baseline and after 3rd and 6th cycle. Intention to treat analysis was done. Results: Baseline characteristics were well matched in 2 arms. At a median follow up 14.4 months (95% CI 13.2-15.7), the median serological PFS is better for patients in Arm B 5.1 months (95%CI 3.13-10.33) compared to 3.4 months (95%CI 3-6.53) in arm A ( P= 0.045). Median overall survival (OS) is not reached in arm B versus 11.2 months (95%CI 5.66-NR) in arm A (P= 0.032). Disease progression was seen in 42.1% (n = 16) in Arm A versus 40.5 %(n = 15) in arm B ( P= 0.40). Sixteen patients are maintaining response. Mucositis (29.7% n = 11) and fatigue (13.5%, n = 5) were more in the pazopanib-containing arm ( P= 0.36). Serum VEGF demonstrated significant decline with subsequent cycles of therapy {median values (range): Arm A, baseline; 466.0 pg/mL(123.9-1930) vs. 6 cycles; 92.05pg/ mL(42.34-279.5) P< 0.0001; Arm B, baseline; 382.0 pg/mL(49.44-2054.0) vs 6 cycles; 119.7 pg/mL(18.20-367.5) P= 0.013} without any difference between the two arms ( P= 0.18). QoL symptom scales in both QLQC 30 and OV 28 questionnaires indicated small but significant improvement in pazopanib arm ( P= 0.02) without differences in global (p = 0.96) and physical functioning scales. ( P= 0.68). Conclusions: Addition of pazopanib to etoposide and cyclophosphamide resulted in improvement in serological PFS and OS with a well-tolerated toxicity profile and modest improvement in QoL.Serum VEGF expression requires validation in a larger cohort. Clinical trial information: CTRI/2017/10/010219.

scholarly journals Factors of Anti-Vascular Endothelial Growth Factor Therapy Withdrawal in Patients with Neovascular Age-Related Macular Degeneration: Implications for Improving Patient Adherence

2021 ◽  
Vol 10 (14) ◽  
pp. 3106
Author(s):  
Fumi Gomi ◽  
Reiko Toyoda ◽  
Annabelle Hein Yoon ◽  
Kota Imai
Keyword(s):  
Quality Of Life ◽  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Financial Burden ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Age Related ◽  
Endothelial Growth Factor

We investigated the factors associated with the discontinuation of anti-vascular endothelial growth factor (VEGF) therapies in patients with neovascular age-related macular degeneration (AMD). Japanese patients with AMD aged ≥50 years, reporting at least one prior injection of an anti-VEGF drug, completed an online survey covering reasons for discontinuation or dissatisfaction with therapy, quality of life (EQ-5D-5L) and patient activation (PAM-13). The respondents were divided into two cohorts: Cohort 1—patients who discontinued anti-VEGF therapy (n = 207); Cohort 2—patients continuing anti-VEGF therapy (n = 65). The most common reason for discontinuing therapy was the “doctor’s decision” in 89.4% (Cohort 1-1). In the other 22 (10.6%) patients in Cohort 1 (Cohort 1-2), reasons included “no deterioration in vision”, “financial burden” and “ineffective treatment”. Patients in Cohort 2 were dissatisfied with “long waiting times” (77%), “financial burden” and “ineffective treatment”. Pain/discomfort posed the greatest impact on quality of life. Only 5% of patients in Cohorts 1-1 and 2 and none in Cohort 1-2 were considered advocates for their own health. In conclusion, most patients who discontinued anti-VEGF therapy did so at their doctor’s decision. Addressing the reasons associated with discontinuation or dissatisfaction with anti-VEGF therapies might help improve their continuation.

scholarly journals Vascular Endothelial Growth Factor Biology and Its Potential as a Therapeutic Target in Rheumatic Diseases

2021 ◽  
Vol 22 (10) ◽  
pp. 5387
Author(s):  
Thi Hong Van Le ◽  
Sang-Mo Kwon
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Rheumatic Diseases ◽  
Treat To Target ◽  
Vegf Receptor ◽  
Vascular Endothelial ◽  
Physiological Processes ◽  
Life Threatening ◽  
Endothelial Growth Factor

Rheumatic diseases constitute a diversified group of diseases distinguished by arthritis and often involve other organs. The affected individual has low quality of life, productivity even life-threatening in some severe conditions. Moreover, they impose significant economic and social burdens. In recent years, the patient outcome has been improved significantly due to clearer comprehension of the pathology of rheumatic diseases and the effectiveness of “treat to target” therapies. However, the high cost and the adverse effects are the concerns and full remissions are not often observed. One of the main processes that contributes to the pathogenesis of rheumatic diseases is angiogenesis. Vascular endothelial growth factor (VEGF), a central mediator that regulates angiogenesis, has different isoforms and functions in various physiological processes. Increasing evidence suggests an association between the VEGF system and rheumatic diseases. Anti-VEGF and VEGF receptor (VEGFR) therapies have been used to treat several cancers and eye diseases. This review summarizes the current understanding of VEGF biology and its role in the context of rheumatic diseases, the contribution of VEGF bioavailability in the pathogenesis of rheumatic diseases, and the potential implications of therapeutic approaches targeting VEGF for these diseases.

scholarly journals Retrograde Amnesia and Disorientation after Intraocular Injection of Anti-VEGF Agents

2018 ◽  
Vol 2 (2) ◽  
pp. 10-13 ◽  
Author(s):  
Peter-Wolfgang Meyer ◽  
Matthias N. Ungerer ◽  
Johannes Schröder
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Retrograde Amnesia ◽  
Temporal Correlation ◽  
Vascular Endothelial ◽  
Potential Side Effect ◽  
Potential Association ◽  
Patient Reported ◽  
Endothelial Growth Factor ◽  
Growth Factor Treatment

We present a case of a 77-year-old male patient who was treated in our outpatient clinic for memory disorders because of episodic confusion and retrograde amnesia. The patient reported having symptoms repeatedly following intraocular treatment with Anti-Vascular Endothelial Growth Factor Agents (Ranibizumab and Bevacizumab) as a treatment for wet macular degeneration. EEG showed a localized deceleration that intensified under prolonged voluntary hyperventilation. Symptoms resolved after the intraocular Anti-Vascular Endothelial Growth Factor treatment was stopped and anticonvulsive treatment with lamotrigine was begun. This case is important in that it describes a potential association between intraocular treatments with Anti-Vascular Endothelial Growth Factor Agents and seizures. Symptoms occurred in temporal correlation with intraocular treatment. Clinicians should be aware of this potential side effect on intraocular treatment with Anti-Vascular Endothelial Growth Factor Agents in patients with high risk for seizures.

scholarly journals Paths for Improving Bevacizumab Available in 2018: The ADZT Regimen for Better Glioblastoma Treatment

2018 ◽  
Vol 6 (4) ◽  
pp. 84
Author(s):  
Richard Kast
Keyword(s):  
Quality Of Life ◽  
Monoclonal Antibody ◽  
Vascular Endothelial Growth Factor ◽  
Treatment Protocol ◽  
Research Data ◽  
Vascular Endothelial ◽  
Research Papers ◽  
Endothelial Growth Factor ◽  
Old Drugs

During glioblastoma treatment, the pharmaceutical monoclonal antibody to vascular endothelial growth factor A, bevacizumab, has improved the quality of life and delayed progression for several months, but has not (or only marginally) prolonged overall survival. In 2017, several dramatic research papers appeared that are crucial to our understanding of glioblastoma vis-a-vis the mode of action of bevacizumab. As a consequence of these papers, a new, potentially more effective treatment protocol can be built around bevacizumab. This is the ADZT regimen, where four old drugs are added to bevacizumab. These four drugs are apremilast, marketed to treat psoriasis, dapsone, marketed to treat Hansen’s disease, zonisamide, marketed to treat seizures, and telmisartan, marketed to treat hypertension. The ancillary attributes of each of these drugs have been shown to augment bevacizumab. This paper details the research data supporting this contention. Phase three testing of AZDT addition to bevacizumab is required to establish safety and effectiveness before general use.

scholarly journals Lymphatic compensation during the postoperative period after breast cancer treatment with axillary dissection

2015 ◽  
Vol 14 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Mariana Maia Freire de Oliveira ◽  
Maria Teresa Pace do Amaral ◽  
Maria Salete Costa Gurgel
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Risk Factors ◽  
Vascular Endothelial Growth Factor ◽  
Health Professionals ◽  
Axillary Dissection ◽  
Breast Cancer Treatment ◽  
Vascular Endothelial ◽  
Endothelial Growth Factor

Lymphedema secondary to breast cancer causes physical and psychological morbidity and compromises quality of life. The objective of this literature review was to study lymphatic compensation after surgery for breast cancer and the factors that influence this process, with a view to understanding the etiopathogenesis of lymphedema. Articles indexed on Pubmed published from 1985 to 2012 were reviewed. According to the literature, lymphangiogenesis reduces damage to lymph vessels; there is little evidence that Vascular Endothelial Growth Factor is elevated in women with lymphedema; lymphovenous communications can be observed 60 days after surgery; women without lymphedema have acquired alternative mechanisms for removal of proteins from the interstitial space; and active exercise stimulates lymphatic and venous pumping. Health professionals should teach these patients about the risk factors for lymphedema. The effects of lymphangiogenesis, proteolysis and lymphovenous communications on development of lymphedema should be studied, since these events are intimately related.

Intralesional Bevacizumab for the Treatment of Recurrent Sinonasal Hemangioma

2018 ◽  
Vol 127 (12) ◽  
pp. 969-973
Author(s):  
Michael R. Kinzinger ◽  
E. Bradley Strong ◽  
Joan Bernard ◽  
Toby O. Steele
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Nasal Obstruction ◽  
Local Excision ◽  
Revision Surgery ◽  
Wide Local Excision ◽  
Vascular Endothelial ◽  
Recurrent Epistaxis ◽  
Patient Reported ◽  
Endothelial Growth Factor

Introduction: Sinonasal hemangioma is a rare benign tumor of vascular endothelial cells. The pathogenesis is closely linked to abnormalities in the vascular endothelial growth factor signaling pathway. Multiple treatment modalities are available, though wide local excision remains the preferred treatment. Bevacizumab, an anti–vascular endothelial growth factor monoclonal antibody, has known efficacy against hemangiomas, though there are no cases of sinonasal hemangiomas managed with bevacizumab. Methods: Case report. Results: The authors review the case of a 67-year-old man with a left-sided nasal hemangioma originating from the nasal septum. He presented with progressive left nasal obstruction and recurrent epistaxis. At the time of his presentation, the lesion had recurred after 1 excision/polypectomy at an outside institution. He then underwent revision surgery via wide local excision and septoplasty. After tumor recurrence following the revision surgery, the hemangioma was noted to recur on 1 year postoperative surveillance nasal endoscopy. In-office intralesional injection of 50 mg bevacizumab was then performed under endoscopic visualization. No improvement in the tumor size was noted at 2 months after injection, with the tumor measuring 1.5 cm. At the 10-month surveillance clinical visit following injection, the tumor had dramatically involuted to 3 mm in greatest dimension. The patient reported complete resolution of his primary symptoms of epistaxis and nasal obstruction. Conclusions: This report demonstrates the first reported successful treatment of a sinonasal hemangioma with intralesional bevacizumab. Intralesional bevacizumab confers an additional option for adjuvant treatment of sinonasal hemangiomas. Further evaluation of intralesional bevacizumab in the treatment of these tumors is warranted.

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