Anti-VEGF Therapy Possibly Extends Survival in Patients With Colorectal Brain Metastasis by Protecting Patients From Neurologic Disability

• Published in: Clinical colorectal cancer 2023-09, Vol.22 (3), p.267-279
• Main Authors: Chen, Chih-Wen, Ou, Tao-Shen, Chen, Wei-Shone, Jiang, Jeng-Kai, Yang, Shung-Haur, Wang, Huann-Sheng, Chang, Shih-Ching, Lan, Yuan-Tzu, Lin, Chun-Chi, Lin, Hung-Hsin, Huang, Sheng-Chieh, Cheng, Hou-Hsuan, Yang, Yi-Wen, Lin, Yu-Zu, Chao, Yee, Wang, Ling-Wei, Teng, Hao-Wei
• Format: Article
• Language: English
• Subjects: Anti-angiogenesis therapy; Colorectal cancer; Gene Ontology; Overall Survival
• ISSN: 1533-0028; 1938-0674
• DOI: 10.1016/j.clcc.2023.03.003

Colorectal brain metastases (CBMs) are rare with poor prognosis. There is still no standard systemic treatment for multiple or unresectable CBM. our study aimed to explore the impact of anti-VEGF therapy on overall survival, brain-specific disease control, and neurologic symptom burden in patients with CBM. A total of 65 patients with CBM under treatment were retrospectively enrolled and divided into anti-VEGF based systemic therapy or non–anti-VEGF based therapy. A total of 25 patients who received at least 3 cycles of anti-VEGF agent and 40 patients without anti-VEGF therapy were analyzed by endpoints of overall survival (OS), progression-free survival (PFS), intracranial PFS (iPFS) and neurogenic event-free survival (nEFS). Gene expression in paired primary metastatic colorectal cancer (mCRC), liver, lung and brain metastasis from NCBI data was analyzed using top Gene Ontology (GO) and cBioPortal. Patients who treated with anti-VEGF therapy had significantly longer OS (19.5 vs. 5.5 months, P = .009), iPFS (14.6 vs. 4.1 months, P < .001) and nEFS (17.6 vs. 4.4 months, P < .001). Patients who received anti-VEGF therapy beyond any disease progression presented with superior OS (19.7 vs. 9.4 months, P = .039). Top GO and cBioPortal analysis revealed a stronger molecular function of angiogenesis in intracranial metastasis. Anti-VEGF based systemic therapy showed favorable efficacy that was reflected in longer overall survival, iPFS and NEFS in patients with CBM. The colorectal brain metastases (CBM) are rare, ominous and related to a dismal prognosis. There was still no standard systemic treatment for multiple or unresectable CBM. Due to highly systemic disease control rate by anti-VEGF therapy observed in patients with brain metastases from different cancers, our study was aimed to explore the impact of anti -VEGF therapy on overall survival, brain-specific disease control, and neurologic symptom burden in patients with CBM.