Efficacy and safety of bevacizumab treatment for refractory brain edema

Abstract

Objective:This retrospective study investigated the efficacy and safety of bevacizumab treatment for refractory brain edema.Methods:Between March 2009 and December 2015, bevacizumab was used to treat 59 cases of brain metastatic patients with refractory brain edema. The median dose of bevacizumab was 4.68 mg/kg (range 2.8–6.52 mg/kg). The clinical-pathological data, the efficacy, and the side effects of bevacizumab were recorded. Magnetic resonance imaging (MRI) was performed before and after bevacizumab treatment. Tumor and edema volumes were measured separately.Results:The clinical symptoms of 50 out of 59 cases (84.74%) improved the day after the bevacizumab treatment, and the edema volumes of 55 (93.22%) cases were reduced after the bevacizumab treatment. The average edema volume was significantly reduced after bevacizumab treatment from 125,583.43 ± 14,093.27 to 71,613.42 ± 9473.42 mm3 (Mann–Whitney rank test, P < .01), and the average edema index was significantly reduced from 25.66 ± 11.54 to 17.87 ± 6.87 (Mann–Whitney rank test, P < .01). One patient died from a hemorrhage due to a cancerous-ulcer of the maxillary sinus. The main complication observed was hypertension, which was observed in 11 cases (18.6%).Conclusion:The effective rate of bevacizumab for refractory brain edema is 84.74%. Hypertension was the main side effect of the bevacizumab treatment. Bevacizumab is an effective and relatively safe treatment for brain edema.

Stereotactic radiosurgery combined with anlotinib for limited brain metastases with perilesional edema in non‐small cell lung cancer: Rvision‐001 study protocol

“…In this study, the brain edema index was used as the main efficacy index to estimate the sample size. With reference to the relevant data of the antiangiogenic drug bevacizumab for the treatment of cerebral edema, the self‐control before and after treatment: the cerebral edema index before treatment was 15.51 ± 7.10, the cerebral edema index after treatment was 9.02 ± 4.40, and the difference between the cerebral edema index before and after treatment was 6.49. The combined standard deviation is seven, the one‐sided test level α is 0.05, and the statistical power of 0.90.…”

“…Vascular endothelial growth factor (VEGF) promotes angiogenesis and increases vascular permeability, and antiangiogenic drugs theoretically have the effect of reducing cerebral edema . Anlotinib is a multitargeted tyrosine kinase receptor inhibitor, especially for vascular endothelial cell growth factor receptor 2 (VEGFR2) and VEGFR3, and is approved for third‐line treatment of non‐small cell lung cancer (NSCLC) .…”

VEGF Signaling in Neurological Disorders

“…One of the best-known anti-angiogenic therapies for cancer treatment had adopted VEGF inhibition (bevacizumab) in combination with EGFR tyrosine kinase inhibitor (Erlotinib) for patients with recurrent non-small-cell lung cancer [ 62 ]. Although anti-VEGF therapy, for instance with bevacizumab, does have side effects such as hypertension [ 63 ] and thereby careful treatment strategy is recommended [ 64 ], the success of clinical trials in cancer with double anti-angiogenic approaches has motivated researchers in cerebrovascular diseases to focus on both VEGF and EGFR signaling pathways.…”

Challenging Hurdles of Current Targeting in Glioblastoma: A Focus on Immunotherapeutic Strategies

“…In the end, corticosteroids mainly appear to limit T cell activation, and strategies to rescue immune activation, or alternatives to their use, should be explored. One alternative to corticosteroids for the management of refractory brain edema is bevacizumab [ 127 ], which should not interfere with the immune response. Additionally, complement activation is also liked to brain edema, and inhibitors are being studied [ 128 ].…”