Possible serious side effectsMost serious side effects (not common, but sometimes fatal):GI perforationA hole that develops in your stomach or intestine. Symptoms include pain in your abdomen, nausea, vomiting, constipation, or feverWounds that don’t healA cut made during surgery can be slow to heal or may not fully heal. Avastin should not be used for at least 28 days before or after surgery and until surgical wounds are fully healedSerious bleedingThis includes vomiting or coughing up blood; bleeding in the stomach, brain, or spinal cord; nosebleeds; and vaginal bleeding. If you recentlySevere high blood pressure 18%Blood pressure that severely spikes or shows signs of affecting the brain. Blood pressure should be monitored every 2 to 3 weeks while on Avastin and after stopping treatmentKidney problems 7%These may be caused by too much protein in the urine and can sometimes be fatalInfusion reactions 3%These were uncommon with the first dose (less than 3% of patients). 0.2% of patients had severe reactions. Infusion reactions include high blood pressure or severe high blood pressure that may lead to stroke, trouble breathing, decreased oxygen in red blood cells, a serious allergic reaction, chest pain, headache, tremors, and excessive sweating. Your doctor or nurse will monitor you for signs of infusion reactionsSevere stroke or heart problems 2.6%These may include blood clots, mini-stroke, heart attack, and chest pain. These can sometimes be fatalAbnormal passage in the body 2%This type of passage—known as a fistula—is an irregular connection from one part of the body to another and can sometimes be fatalNervous system and vision problems 0.5%Signs include headache, seizure, high blood pressure, sluggishness, confusion, and blindness
胶质瘤靶向药物分子靶向治疗脑胶质瘤是根据脑胶质瘤发生及生长的分子遗传学信号传导系统设计的,针对性地应用靶点特异性阻断药物,可以明显提高患者无瘤生存期,常用的还有作用于信号传导通路的一些药物,因肿瘤的生长要有信号传递,如果信号传递被中止,肿瘤就会凋亡。靶向血管内皮生长因子(vascular endothelial growth factor, VEGF)的重组人单克隆IgG1抗体贝伐单抗(Bevacizumab)。贝伐单抗药物多用于肿瘤的复发,肿瘤的生长增殖需要不断的新生血管来提供,所以新生血管是肿瘤的特征,而VEGF单抗(如贝伐单抗)是目前神经系统恶性肿瘤最常用的分子靶向药物,可有效的抑制新生血管生成会对肿瘤的生长起到明显的治疗效果。贝伐单抗是胶质瘤治疗的二线药物,常用的有靶向血小板衍生的生长因子受体(platelet-derived growth factor receptor , PDGFR)的小分子酪氨酸激酶抑制剂伊马替尼(imatinib)、靶向表皮生长因子受体(epidermal growth factor receptor, EGFR)的小分子酪氨酸激酶抑制剂吉非替尼(gefitinib)。张雷观点:贝伐单抗国内常用, 但美国2014年就已经发现它不会延长胶母的生存时间!用药后肿瘤明显缩小, 但以后马上疯长。No Survival Benefit for Avastin in GlioblastomaSource Reference:Chinot OL, et al "Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma"N Engl J Med2014; 370: 709-722.Gilbert MR, et al "A randomized trial of bevacizumab for newly diagnosed glioblastoma"N Engl J Med2014; 370: 677-708.Fine HA "Bevacizumab in glioblastoma -- still much to learn"N Engl J Med2014; 370: 764-765.http://www.medpagetoday.com/HematologyOncology/BrainCancer/44383
N Engl J Med.2016 Nov 3;375(18):1749-1755.Fulminant Myocarditis with Combination Immune Checkpoint Blockade.AbstractImmune checkpoint inhibitors have improved clinical outcomes associated with numerous cancers, but high-grade, immune-related adverse events can occur, particularly with combination immunotherapy. We report the cases of two patients with melanoma in whom fatal myocarditis developed after treatment with ipilimumab and nivolumab. In both patients, there was development of myositis with rhabdomyolysis, early progressive and refractory cardiac electrical instability, and myocarditis with a robust presence of T-cell and macrophage infiltrates. Selective clonal T-cell populations infiltrating the myocardium were identical to those present in tumors and skeletal muscle. Pharmacovigilance studies show that myocarditis occurred in 0.27% of patients treated with a combination of ipilimumab and nivolumab, which suggests that our patients were having a rare, potentially fatal, T-cell-driven drug reaction. (Funded by Vanderbilt-Ingram Cancer Center Ambassadors and others.).PMID:27806233