Role of Bevacizumab as a prophylactic and rehabilitative treatment modality in cases of sporadic and syndromic vestibular schwannoma: Fifty shades of grey!

Tripathi, Manjul; Deora, Harsh; Kumar, Narendra; Batish, Aman; Dutta, Pinaki; Gurnani, Jenil; Mohindra, Sandeep; Shahid, Adnan Hussain; Kataria, Ketan; Agrahari, Abhinav; Kataria, Mandeep Singh; Ahuja, Chirag; Singh, Paramjeet

doi:10.1016/j.inat.2019.100607

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…It is a commonly used drug among various chemotherapy regimens. It also has an emerging role in managing radiation-induced brain oedema and necrosis 2 3. Here, we report a patient who developed a grade 3 papulopustular eruption secondary to bevacizumab, and responded to a combination of dose-reduction and topical/oral antibiotics.…”

Section: Introductionmentioning

confidence: 94%

PRIDE complex-like skin rash associated with bevacizumab

et al. 2022

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Bevacizumab-induced rash is a rarely reported complication with very few insights into its epidemiology, pathophysiology, management and relationship with therapeutic efficacy. We report a case of ruptured occipital arteriovenous malformation treated with stereotactic radiosurgery. The patient developed steroid-resistant radiosurgery-induced brain oedema. Oedema partially responded to bevacizumab, and the patient tolerated the treatment well except for skin rash. He developed multiple discrete monomorphic papulopustular lesions with intervening hyperpigmented macules after bevacizumab intravenous infusion. The patient was further treated with benzoyl peroxide gel for local application and oral doxycycline. The rash reappeared whenever bevacizumab was reintroduced to the regimen beyond 7.5 mg/kg body weight at 3 weekly intervals. After dose modification to 5 mg/kg body weight, 6 cycles were administered with no further rash and resolution of oedema. There is no need to halt bevacizumab therapy, although it can be continued at a lesser dose as it may be a dose-dependent complication.

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Section: Introductionmentioning

confidence: 94%

PRIDE complex-like skin rash associated with bevacizumab

et al. 2022

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“…To overcome this dilemma, intravenous chemotherapy with Bevacizumab (BZA) has been introduced in the last decade as one of the treatment options for NF2 patients. BZA works as a monoclonal antibody against the vascular endothelial growth factor [136]. The use of BZA was initially proposed by Plotkin et al and offered to 10 NF2 confirmed patients whom they have an evidence of tumor progression and considered poor candidates for surgery and radiotherapy or refused these treatments.…”

Section: Medical Therapy and Nf2 Vsmentioning

confidence: 99%

Therapy of Sporadic and NF2-Related Vestibular Schwannoma

Yao

Alahmari

Temel

et al. 2020

Cancers

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Vestibular schwannoma (VS) is a benign primary brain tumor that occurs sporadic or as part of a genetic syndrome. The most common cause is the mutation of the NF2 tumor suppressor gene that is involved in the production of the protein merlin. Merlin plays a role in cell growth and cell adhesion. In patients with NF2, the VSs arise bilaterally and coincide with other brain tumors. In sporadic VS, the tumor is typically unilateral and does not coincide in combination with other tumors. MRI is the standard imaging technique and can be used to assess the size and aspect of the tumor as well as the progression of disease. The preferred management of large VS in both VS types is surgery with or without adjuvant radiation. The management for the medium- or small-sized VS includes wait and scan, radiotherapy and/or surgery. This choice depends on the preference of the patient and institutional protocols. The outcomes of surgical and radiotherapy treatments are improving due to progress in surgical equipment/approaches, advances in radiation delivery techniques and dose optimizations protocols. The main purpose of the management of VS is preserving function as long as possible in combination with tumor control.

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“…Currently, there are no approved drugs for the treatment of NF2 SWN or VS. Multiple studies have trialled the use of bevacizumab, an inhibitor of angiogenesis, in NF2 SWN-related VS and found a reduction in tumour growth and hearing stabilisation or improvement [15][16][17][18] , but treatment toxicity such as hypertension, proteinuria and renal impairment are common, and many individuals treated with bevacizumab become refractory, resulting in uncontrolled growth and progressive hearing loss [19][20][21] . The current lack of alternative treatments for NF2 SWN-related VS is a consequence of our limited understanding of the biology of NF2-SWN-related VS tumours.…”

Section: Introductionmentioning

confidence: 99%

High-Dimensional Imaging of Vestibular Schwannoma Reveals Distinctive Immunological Networks Across Histomorphic Niches inNF2-related Schwannomatosis

Jones,

Haley,

Gregory

et al. 2024

Preprint

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NF2-related Schwannomatosis (NF2 SWN) is a rare tumour-predisposition syndrome characterised by the growth of multiple central and peripheral nervous system neoplasms. The drivers of NF2 SWN are pathogenic variants in the tumour suppressor gene NF2, encoding the protein Merlin, leading to development of bilateral vestibular schwannoma (VS) in >95% of patients. VS tumours are characterised by infiltration of myeloid cells and lymphocytes, highlighting the potential of immunotherapy for VS. However, the immunological landscape in VS and the spatial determinants within the tumour microenvironment that shape the trajectory of disease are presently unknown. In this study, to elucidate the complex immunological networks across VS, we performed imaging mass cytometry (IMC) on clinically annotated VS samples from NF2 SWN patients. We reveal the heterogeneity in neoplastic cell, myeloid cell and T cell populations that co-exist within VS, determining that the cellular composition of VS tumours is independent of NF2-SWN genetic severity. We show that distinct myeloid cell and Schwann cell populations exist within varied spatial contextures across characteristic Antoni A and B histomorphic niches. Interestingly, we show that T-cell populations associate with tumour-associated macrophages (TAMs) in Antoni A regions, seemingly limiting their ability to interact with tumorigenic Schwann cells. This spatial landscape is altered in Antoni B regions, where T-cell populations appear to interact with PD-L1+ Schwann cells. We also demonstrate that prior bevacizumab treatment (VEGF-A antagonist) preferentially reduces alternatively-activated TAMs, whilst enhancing CD44 expression, in bevacizumab-treated tumours. Together, we describe niche-dependent modes of T-cell regulation in NF2 SWN VS, indicating the potential for microenvironment-altering therapies for VS.

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Role of Bevacizumab as a prophylactic and rehabilitative treatment modality in cases of sporadic and syndromic vestibular schwannoma: Fifty shades of grey!

Cited by 5 publications

References 14 publications

PRIDE complex-like skin rash associated with bevacizumab

PRIDE complex-like skin rash associated with bevacizumab

Therapy of Sporadic and NF2-Related Vestibular Schwannoma

High-Dimensional Imaging of Vestibular Schwannoma Reveals Distinctive Immunological Networks Across Histomorphic Niches inNF2-related Schwannomatosis

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