International journal of radiation oncology, biology, physics 2015-07-01
Gastrointestinal Toxicities With Combined Antiangiogenic and Stereotactic Body Radiation Therapy.
Abstract
Combining the latest targeted biologic agents with the most advanced radiation technologies has been an exciting development in the treatment of cancer patients. Stereotactic body radiation therapy (SBRT) is an ablative radiation approach that has become established for the treatment of a variety of malignancies, and it has been increasingly used in combination with biologic agents, including those targeting angiogenesis-specific pathways. Multiple reports have emerged describing unanticipated toxicities arising from the combination of SBRT and angiogenesis-targeting agents, particularly of late luminal gastrointestinal toxicities. In this review, we summarize the literature describing these toxicities, explore the biological mechanism of action of toxicity with the combined use of antiangiogenic therapies, and discuss areas of future research, so that this combination of treatment modalities can continue to be used in broader clinical contexts.
Related Questions
How would you approach potential SBRT to liver metastases in a patient on a VEGF inhibitor?
For patients who are on VEGF inhibitors, I would be very careful with dosing of radiation to nearby bowel and I discuss holding VEGF inhibitors for a time before, during and after radiation. There have been multiple reports of in field toxicity, particularly with respect to bowel (liver SBRT frequen...
What are your recommendations for holding bevacizumab before and after SBRT to the lung?
As @Dr. First Last notes, our experience at Memorial Sloan Kettering has indicated that giving SBRT for ultra-central lung tumors in a patient who has also been exposed to VEGF inhibitors may be an extremely dangerous combination associated with a high risk of fatal pulmonary hemorrhage. This work w...