Young brain cancer patients have been fighting cancer for 13 years, what is the credit of this targeted drug?

The treatment of brain cancer has always been a problem, and there are not many breakthroughs

First-line treatment of glioblastoma polymorphic

Glioblastoma polyforma (GBM) is one of the most common and aggressive malignancies of the central nervous system, accounting for 14.

Initial diagnosis of glioblastoma polymorphic is maximally surgically removed, with chemoradiation with temozolomide and subsequent adjuvant therapy with temozolomide alone for 6 cycles

How is recurrent brain cancer treated?

However, glioblastoma polymorphic has a higher risk of recurrence, and once the disease recurs, treatment options are more limited

Lomustine is an alkylating agent commonly used in second-line therapy after failure of temozolomide therapy, with a median progression-free survival of 1.

Overall, second-line treatment for glioblastoma polyforma lacks excellent treatment.

Rigofenib is a multi-target anti-angiogenic targeted drug

What exactly is the efficacy of regofenib? Let's take a look at the following examples
.

Patients with recurrent brain cancer benefit from treatment with rigofenib

In 2007, a 28-year-old patient developed multiple seizures over several months when an MRI of the brain revealed a lump
in the left frontal lobe.

The patient underwent surgery followed by adjuvant radiotherapy, while taking temozolomide, and continued treatment with temozolomide for 6 cycles
after the end of chemoradiotherapy.

In September 2018, more than ten years after the last treatment, the patient's left frontal lobe once again appeared a 2.
6 cm ✖1.
8 cm lump, the patient felt headache, fatigue and tension, and the condition recurred
.

In October 2018, the patient underwent surgery again, and the postoperative pathological diagnosis confirmed that it was a high-grade glioma, that there was no mutation in the IDH gene, that 1p19q was non-co-deletion, and that the promoter of MGMT was methylated
.

From the above three mutation tests, patients do not benefit
from chemotherapy in the long term.

Postoperative brain enhancement MRI found that there were residual lesions after surgery, and in January 2019 the patient underwent a second phase of radiotherapy, followed by the use of temozolomide
again.

Unfortunately, on the 40th day after radiation therapy, the BRAIN MRI showed progression and the associated clinical symptoms began to worsen
.

Despite intravenous therapy with antiemetics and steroids, patients still had severe headaches, cognitive changes, and vomiting
3 times a day.

As a last resort, patients bevacizumab combined with irinotecan were initiated for treatment over an overall period of 12 cycles and were well
tolerated.

Clinical evaluation was stable and the overall benefit was 12 months
.

In May 2020, MRI again showed the progression of brain lesions, and the patient's headache began to worsen, personality changes, movement disorders and memory loss
.

After treatment with mannitol and steroids, palliative radiotherapy
was initiated.

Figure 1.
Previous treatment of brain MRI was used in July 2020 with rigofenib

In July 2020, patients began third-line therapy
with rigofenib.

From day 1 to day 21, 160 mg of rigofenib is used daily, followed by discontinuation of the drug for 7 days and 28 days for a treatment cycle
.

After treatment with rigofenib, the patient's condition was stable and the benefit time was up to 8 months
.

It is also well tolerated, with only first-degree hypertension
.

From the sixth cycle, the dose of rigofenib is reduced to 120 mg per day and treatment
with antioxidant supplements is initiated.

Figure 2.
In August 2021, brain magnetic examination confirmed the progression of the disease

revelation

Currently, only the Guidelines of the Italian Society of Medical Oncology recommend rigofenib as the drug of choice for recurrent polyglioblastoma, and the US, European and domestic guidelines do not have this recommendation
.

In the case of patients, the benefit time of regofenib on the third line was up to 9 months
, which was very difficult.

Generally speaking, high-grade gliomas with wild-type and MGMT promoter methylation of the IDH gene have a median progression-free survival time of about two years, but the patients in the case survived more than two years
after second- and third-line treatment.

Treatment measures for brain malignancies have been lacking important breakthroughs, and the multi-target targeted drug regofenib has given us a glimmer of light
.

Will other multi-target targeted drugs such as sorafenib and renvatinib also have good results? We hope that there will be more relevant clinical trial data to confirm
it.

Regarding the literature in this regard, the cancer degree will also be followed up in time for everyone
.

For more anti-cancer information, please pay attention to the cancer degree public number and download the cancer degree app!

References: Mario Pirozzi, et al.
Regorafenib beyond the Second Line in Relapsed Glioblastoma: A Case Report and Literature Review.
Case Rep Oncol.
2022 Jun 27; 15(2):642-647.

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