Bevacizumab in high-grade glioma patients following intraparenchymal hemorrhage Journal Article

   


Authors: Lin, X.; Daras, M.; Pentsova, E.; Nolan, C. P.; Gavrilovic, I. T.; DeAngelis, L. M.; Kaley, T. J.
Article Title: Bevacizumab in high-grade glioma patients following intraparenchymal hemorrhage
Abstract: Background: Intraparenchymal hemorrhage (IPH) is a relative contraindication to bevacizumab therapy, an anti-vascular endothelial growth factor (VEGF) monoclonal antibody approved for the treatment of recurrent glioblastoma. However, in patients with symptomatic enhancing tumors and poor functional status, bevacizumab may be the only beneficial therapeutic option. Methods: We retrospectively reviewed all patients with high-grade glioma who were treated between January 1, 2005 and December 31, 2014 with bevacizumab despite prior IPH. Results: Eighteen patients met our study criteria. There were 12 women and 6 men with a median age of 56 years. Tumor types were glioblastoma (n = 15), anaplastic astrocytoma (n = 2), and anaplastic oligodendroglioma (n = 1). Seventeen patients had prior spontaneous intratumoral bleed (13 grade 1-2; 4 grade 3-4); the 1 remaining patient had a grade 3 bleed due to cerebral venous thrombosis. Among them, identifiable risk factors for hemorrhage were anti-VEGF therapy, anticoagulation use, thrombocytopenia, and hypertension; seven had no identifiable risk factors. The median duration from IPH to (re-)initiation of bevacizumab was 113 days (range 13-1367). Brain imaging performed prior to bevacizumab treatment showed persistent or evolving hemorrhage in 8 patients and complete resolution in 10 patients. With a median follow-up duration of 137 days after bevacizumab re-initiation, only 1 (6%) of the 18 patients re-bled; this patient had an anaplastic oligodendroglioma and developed a grade 2 intratumoral bleed after 3 doses of bevacizumab. Conclusions: The incidence of re-bleed is rare. Bevacizumab use was safe in patients with recurrent high-grade glioma following IPH for whom no other meaningful treatment options existed. © The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved.
Keywords: adult; clinical article; treatment outcome; middle aged; bevacizumab; drug withdrawal; nuclear magnetic resonance imaging; glioma; computer assisted tomography; retrospective study; tumor recurrence; glioblastoma; vascular endothelial growth factor; oligodendroglioma; tumor growth; wound infection; brain hemorrhage; tumor bleeding; intracranial hemorrhage; cerebral sinus thrombosis; human; male; female; priority journal; article
Journal Title: Neuro-Oncology Practice
Volume: 4
Issue: 1
ISSN: 2054-2577
Publisher: Oxford University Press  
Date Published: 2017-03-01
Start Page: 24
End Page: 28
Language: English
DOI: 10.1093/nop/npw008
PROVIDER: scopus
PMCID: PMC6479824
PUBMED: 31044081
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85047052722&doi=10.1093%2fnop%2fnpw008&partnerID=40&md5=2a1057c8626a451ddce79c558e43714b
Notes: Article -- Export Date: 1 June 2018 -- Source: Scopus
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MSK Authors
  1. Lisa De Angelis
    576 De Angelis
  2. Igor T Gavrilovic
    73 Gavrilovic
  3. Thomas Kaley
    154 Kaley
  4. Elena Pentsova
    132 Pentsova
  5. Craig Nolan
    59 Nolan
  6. Mariza Daras
    27 Daras
  7. Xuling Lin
    15 Lin
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