The benefit of bevacizumab therapy in patients with refractory vasogenic edema caused by brain metastasis from lung and colon cancers

Abstract

ObjectiveThis retrospective study investigated the efficacy of bevacizumab in refractory brain edema caused by brain metastasis from lung cancer and colon cancer.MethodsA total of 72 patients with refractory brain edema were divided into the lung cancer and colon cancer groups according to their primary tumor. All patients received a single bevacizumab treatment for refractory brain edema. MRI was performed 1 week before the treatment and 4 weeks after the treatment. The edema and tumor volumes were calculated using imaging modalities.ResultsAfter a single bevacizumab treatment, the refractory brain edema of 61 patients was controlled, and the clinical symptoms of 65 patients were improved. The average edema volume before treatment was 201,708.97 ± 61,426.04 mm3, which has decreased to 116,947.01 ± 43,879.16 mm3 after treatment (P < 0.05). After treatment, the edema index decreased from 25.97 ± 7.15 to 17.32 ± 5.24 (P < 0.05).We found that brain edema was controlled in 40 patients (93.02%) in the lung cancer group and 21 patients (72.41%) in the colon cancer group (P<0.05). In addition, 22 patients (88.00%) in the radiotherapy group achieved edema control, compared to 39 (82.98%) in the non-radiotherapy group (P>0.05). Nine patients experienced hypertension after treatment, two patients exhibited decreased platelet counts, and no hemorrhage cases were observed.ConclusionBevacizumab can significantly alleviate refractory brain edema, and there is a significant difference in the efficacy of bevacizumab on refractory brain edema caused by brain metastasis from lung and colon cancers.

Unexpected “Lazarus response” to single-agent bevacizumab in heavily pretreated patients with HER2-positive breast cancer

“…The fourth patient did not have overt symptoms despite significant brain involvement. It is very likely that the striking improvement of the condition of these women was mainly attributed to the bevacizumab-driven resolution of edema, which corresponds well to preclinical data [2,6] and clinical experience concerning the use of this drug [7,10,11]. In addition, a direct antitumor effect of bevacizumab was seen in some of the described cases (Figure 3).…”

“…Standard antiedema therapy did not improve the patient’s condition, so the life expectancy for this woman did not exceed a few days. Recognizing that bevacizumab may decrease intratumoral interstitial pressure and alleviate metastasis-related cerebral edema [ 10 , 11 ], 800 mg (10 mg/kg) of this drug was administered on September 6, 2022. Strikingly, the patient regained full consciousness within 24‒48 h, along with some mobility.…”

Bevacizumab in the Treatment of Refractory Brain Edema in High-grade Glioma

“…Despite the increasing evidence on the efficacy of bevacizumab in the setting of radiation necrosis, the use of this drug to treat refractory brain edema has been mostly anecdotal, mainly in the setting of brain metastasis from lung and colon cancers in adult patients 20 . As for our patients, access to this drug for this indication can be extremely difficult.…”

Clinical diagnostic and radiographic features of recurrent intracranial malignant triton tumor in an adult: illustrative case

“…She was started on bevacizumab, which has been shown to improve PFS in patients with recurrent glioblastoma multiforme and also improves cerebral edema. 41 The use of bevacizumab for the treatment of MTTs has not been previously reported in the literature. Given concerns for continued progression, bevacizumab was later discontinued.…”