Single dose bevacizumab as treatment for symptomatic, corticosteroid-refractory pseudoprogression after chemoradiation therapy for newly diagnosed glioblastoma: A case report

Abstract

The survival of patients with glioblastoma has improved significantly since the introduction of radiation therapy with concurrent and adjuvant temolozolomide as standard therapy. However, symptomatic increases in MRI enhancement and edema mimicking tumor progression (pseudoprogression) have been well described after dual modality chemoradiation. We report the outcome of a glioblastoma patient after the administration of a single dose of bevacizumab for corticosteroidrefractory pseudoprogression. A 60-year old male with an unresectable glioblastoma developed symptoms and MRI changes suggestive of either progression or pseudoprogression during cycle one of adjuvant temozolomide, six weeks after completing treatment with radiation therapy and concomitant temozolomide. The patient's condition's did not respond adequately to high doses of corticosteroids but improved rapidly after a single dose of bevacizumab. MRI taken two weeks after the administration of bevacizumab showed significant improvement. The patient received no further therapy or corticosteroids. Follow-up MRI three months later showed no evidence of progression. We report the case of a glioblastoma patient suspected of developing pseudoprogression after combined modality chemoradiation. The dramatic symptomatic improvement after a single dose of bevacizumab suggests that a short course of the drug may be an effective strategy for the treatment of pseudoprogression in patients who respond poorly to corticosteroids.