Antiangiogéniques et métastases cérébrales: plus de peur que de mal ?

Brain metastases occur in 5% to 20% of cancer patients, depending on the primary tumor type. Several angiogenesis inhibitors have shown clinical efficacy in numerous tumors that frequently metastasize to the brain. However, clinical trials of such angiogenesis inhibitors have excluded patients with brain metastases owing to the theoretical risk of cerebral hemorrhage. Therefore, the available safety data are mainly retrospective: cerebral hemorrhage incidence is estimated to affect 0.1% to 3% of patients treated with angiogenesis inhibitors. Efficacy data are scarce, but case reports of brain metastases with complete and partial responses have been published. Few retrospective reports with few patients suggest that radiation therapy or radiosurgery could be safe. Therefore, available safety data suggest that angiogenesis inhibitor can be used to treat cancer patients with brain metastases. Prospective evaluation is warranted, and cancer patients who harbor brain metastases should not be systematically excluded from prospective clinical trials evaluating angiogenesis inhibitors.