Bevacizumab therapy for adults with recurrent/progressive meningioma: a retrospective series

Lou, Emil; Sumrall, Ashley; Turner, Scott; Peters, Katherine B.; Desjardins, Annick; Vredenburgh, James J.; McLendon, Roger E.; Herndon, James E.; McSherry, Frances; Norfleet, J.; Friedman, Henry S.; Reardon, David A.

doi:10.1007/s11060-012-0861-0

Cited by 174 publications

(116 citation statements)

References 40 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…VEGF inhibitors such as bevacizumab have been shown to reduce baseline peritumoral edema as well as edema following radiosurgery and radiation therapy. 14,15 We have also reported on the use of bevacizumab for arteriovenous malformations and have used it rarely in the setting of other benign intracranial pathologies. 28 While bevacizumab was part of the current study, there is substantial reason to believe that it would be of therapeutic value for meningioma patients with worsening edema and particularly those who are intolerant of, or whose edema is refrac- tory to, corticosteroid treatment.…”

Section: Discussionmentioning

confidence: 99%

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Sheehan

Lee²,

Xu³

et al. 2015

JNS

View full text Add to dashboard Cite

OBJECT Stereotactic radiosurgery (SRS) has been shown to offer a high probability of tumor control for Grade I meningiomas. However, SRS can sometimes incite edema or exacerbate preexisting edema around the targeted meningioma. The current study evaluates the incidence, timing, and degree of edema around parasagittal or parafalcine meningiomas following SRS. METHODS A retrospective review was undertaken of a prospectively maintained database of patients treated with Gamma Knife radiosurgery at the University of Virginia Health System. All patients with WHO Grade I parafalcine or parasagittal meningiomas with at least 6 months of clinical follow-up were identified, resulting in 61 patients included in the study. The median radiographic follow-up was 28 months (range 6–158 months). Rates of new or worsening edema were quantitatively assessed using volumetric analysis; edema indices were computed as a function of time following radiosurgery. Statistical methods were used to identify favorable and unfavorable prognostic factors for new or worsening edema. RESULTS Progression-free survival at 2 and 5 years was 98% and 90%, respectively, according to Kaplan-Meier analysis. After SRS, new peritumoral edema occurred or preexisting edema worsened in 40% of treated meningiomas. The median time to onset of peak edema was 36 months post-SRS. Persistent and progressive edema was associated with 11 tumors, and resection was undertaken for these lesions. However, 20 patients showed initial edema progression followed by regression at a median of 18 months after radiosurgery (range 6–24 months). Initial tumor volume greater than 10 cm3, absence of prior resection, and higher margin dose were significantly (p < 0.05) associated with increased risk of new or progressive edema after SRS. CONCLUSIONS Stereotactic radiosurgery offers a high rate of tumor control in patients with parasagittal or parafalcine meningiomas. However, it can lead to worsening peritumoral edema in a minority of patients. Following radiosurgery, transient edema occurs earlier than persistent and progressive edema. Longitudinal follow-up of meningioma patients after SRS is required to detect and appropriately treat transient as well as progressive edema.

show abstract

Section: Discussionmentioning

confidence: 99%

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Sheehan

Lee²,

Xu³

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…48,61 Bevacizumab (Avastin), a humanized monoclonal antibody direct VEGF inhibitor, has been investigated as a possible therapeutic agent that could halt or reverse tumor-related angiogenesis. Several small-scale retrospective studies have been published, with mixed results, 42,49,55 and there is a need for larger Phase II trials. The VEGF has also been shown to crossactivate other growth factor pathways, 59 an observation that seems to be a recurring theme with new advances in understanding of cell signaling in meningiomas.…”

Section: Angiogenesis Inhibitionmentioning

confidence: 99%

Recent developments in chemotherapy for meningiomas: a review

Moazzam

Wagle

Zada

2013

FOC

View full text Add to dashboard Cite

Object Currently, few medical options exist for refractory and atypical/anaplastic meningiomas. New developments in chemotherapeutic options for meningiomas have been explored over the past decade. The authors review these recent developments, with an emphasis on emerging avenues for therapy, clinical efficacy, and adverse effects. Methods A review of the literature was performed to identify any studies exploring recent medical and chemotherapeutic agents that have been or are currently being tested for meningiomas. Results from included preclinical and human clinical trials were reviewed and summarized. Results Current guidelines recommend only 3 drugs that can be used to treat patients with refractory and highgrade meningiomas: hydroxyurea, interferon-α 2B, and Sandostatin long-acting release. Recent developments in the medical treatment of meningiomas have been made across a variety of pharmacological classes, including cytotoxic agents, hormonal agents, immunomodulators, and targeted agents toward a variety of growth factors and their signaling cascades. Promising avenues of therapy that are being evaluated for efficacy and safety include antagonists of platelet-derived growth factor receptor, epidermal growth factor receptor, vascular endothelial growth factor receptor, and mammalian target of rapamycin. Because malignant transformation in meningiomas is likely to be mediated by numerous processes interacting via a complex matrix of signals, combination therapies affecting multiple molecular targets are currently being explored and hold significant promise as adjuvant therapy options. Conclusions Improved understanding of the molecular mechanisms driving meningioma tumorigenesis and malignant transformation has resulted in the targeted development of more specific agents for chemotherapeutic intervention in patients with nonresectable, aggressive, and malignant meningiomas.

show abstract

“…38,64,73,76,83 One trial with 48 patients having intracranial meningioma who were followed up for a median period of 18 months showed that 29% of these patients had at least a 20% reduction in meningioma volume; 76 however, this reduction was not sustained over time, and a molecular analysis yielded no correlation of VEGF pathway expression with treatment responses. Identifying the critical gene targets in spinal meningioma will improve the design of clinical treatments.…”

Section: Meningiomasmentioning

confidence: 99%

The genetic basis of intradural spinal tumors and its impact on clinical treatment

Karsy

Guan

Sivakumar

et al. 2015

FOC

View full text Add to dashboard Cite

Genetic alterations in the cells of intradural spinal tumors can have a significant impact on the treatment options, counseling, and prognosis for patients. Although surgery is the primary therapy for most intradural tumors, radiochemothera-peutic modalities and targeted interventions play an ever-evolving role in treating aggressive cancers and in addressing cancer recurrence in long-term survivors. Recent studies have helped delineate specific genetic and molecular differences between intradural spinal tumors and their intracranial counterparts and have also identified significant variation in therapeutic effects on these tumors. This review discusses the genetic and molecular alterations in the most common intradural spinal tumors in both adult and pediatrie patients, including nerve sheath tumors (that is, neurofibroma and schwannoma), meningioma, ependymoma, astrocytoma (that is, low-grade glioma, anaplastic astrocytoma, and glioblastoma), hemangioblastoma, and medulloblastoma. It also examines the genetics of metastatic tumors to the spinal cord, arising either from the CNS or from systemic sources. Importantly, the impact of this knowledge on therapeutic options and its application to clinical practice are discussed.

show abstract

Bevacizumab therapy for adults with recurrent/progressive meningioma: a retrospective series

Cited by 174 publications

References 40 publications

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Edema following Gamma Knife radiosurgery for parasagittal and parafalcine meningiomas

Recent developments in chemotherapy for meningiomas: a review

The genetic basis of intradural spinal tumors and its impact on clinical treatment

Contact Info

Product

Resources

About