A pat on the brain.

Top Line: High radiation doses to the lower, pretty important parts of the brain during some definitive head and neck cases can be difficult to avoid.

The Study: How do we manage resulting radiation injury? You’re never wrong if you say steroids. Alternatively, the VEGF-inhibitor bevacizumab has mixed results in diminishing symptoms—the thought process behind this strategy stems from radiation-induced hypoxia understandably stimulating VEGF production, which increases permeability of the blood brain barrier. The downside is, both of those regimens carry undesirable side effect profiles and/or treatment burdens, especially when commiting to several months of therapy. Enter apatinib, the more targeted inhibitor of VEGFR 2 (the main VEGF receptor on endothelial cells). This Chinese single-arm phase 2 trial enrolled 36 patients with radiation-induced brain injury (31 deemed necrosis) 12+ months following head and neck irradiation. They all received apatinib 250 mg orally once daily for 4 weeks. The primary outcome of at least a 25% reduction in edema per T2 FLAIR imaging at 4 weeks was achieved by 22/36 patients (61%). The remaining 14 enrollees failed to demonstrate a response at all subsequent time points, as well, while 12/22 responders (55%) had continued control at 6 months. Additionally, 18/36 patients (50%) had improved neurologic functioning at week 4. In other words, apatinib demonstrated efficacy and safety comparable to that reported for its older cousin bev, but packaged in an easy once-daily pill as opposed to cumbersome infusions.

TBL: The novel VEGFR2-inhibitor apatinib is a promising oral alternative to intravenous bevacizumab for the treatment of radiation-induced brain injury. | He, Int J Radiat Oncol Biol Phys 2022