Intralesional Bevacizumab for the Treatment of Recurrent Sinonasal Hemangioma

Abstract

Introduction: Sinonasal hemangioma is a rare benign tumor of vascular endothelial cells. The pathogenesis is closely linked to abnormalities in the vascular endothelial growth factor signaling pathway. Multiple treatment modalities are available, though wide local excision remains the preferred treatment. Bevacizumab, an anti-vascular endothelial growth factor monoclonal antibody, has known efficacy against hemangiomas, though there are no cases of sinonasal hemangiomas managed with bevacizumab. Methods: Case report. Results: The authors review the case of a 67-year-old man with a left-sided nasal hemangioma originating from the nasal septum. He presented with progressive left nasal obstruction and recurrent epistaxis. At the time of his presentation, the lesion had recurred after 1 excision/polypectomy at an outside institution. He then underwent revision surgery via wide local excision and septoplasty. After tumor recurrence following the revision surgery, the hemangioma was noted to recur on 1 year postoperative surveillance nasal endoscopy. In-office intralesional injection of 50 mg bevacizumab was then performed under endoscopic visualization. No improvement in the tumor size was noted at 2 months after injection, with the tumor measuring 1.5 cm. At the 10-month surveillance clinical visit following injection, the tumor had dramatically involuted to 3 mm in greatest dimension. The patient reported complete resolution of his primary symptoms of epistaxis and nasal obstruction. Conclusions: This report demonstrates the first reported successful treatment of a sinonasal hemangioma with intralesional bevacizumab. Intralesional bevacizumab confers an additional option for adjuvant treatment of sinonasal hemangiomas. Further evaluation of intralesional bevacizumab in the treatment of these tumors is warranted.

VEGF Pathway Gene Expression Profile of Proliferating versus Involuting Infantile Hemangiomas: Preliminary Evidence and Review of the Literature

“…The strongest impact of gene expression profile analysis seems to be on therapy selection and therapy response in different types of hemangiomas. Intralesional injection of bevacizumab (anti-VEGF therapy) has already been applied for retinal [ 46 ], choroidal [ 47 ], and sinonasal hemangiomas [ 48 ] with promising results. An accurate gene expression profile assessment followed by patient stratification will drive the selection of the most targeted therapies.…”

Multimodality treatment of vascular anomalies of the head and neck

“…26,27 There are several reports on resistant IHs being treated successfully with intralesional bevacizumab. 28,29 Further trials or systematic reviews are needed to determine if this is a safe and effective second-line treatment for IHs.…”

“…Vincristine, a chemotherapy, that induces apoptosis of endothelial cells has been shown to be effective as a single weekly dose of 1–1.5 mg/m 2 , 26,27 However, there are significant side effects which include constipation and neuropathy 26,27 . There are several reports on resistant IHs being treated successfully with intralesional bevacizumab 28,29 . Further trials or systematic reviews are needed to determine if this is a safe and effective second‐line treatment for IHs.…”

Pharmacological, Technological, and Digital Innovative Aspects in Rhinology

“…The administration was performed by intralesion injection under endoscopic visualization in a 67-year-old patient. After 10 months, a reduction in the tumor size, a complete resolution of epistaxis and nasal obstruction were observed ( 41 ). Bevacizumab is a mAb that, by binding the growth factor of vascular endothelial cells (VEGF), blocks its biological activity.…”