Bevacizumab in neurofibromatosis type 2 (NF2) related vestibular schwannomas: a nationally coordinated approach to delivery and prospective evaluation
Open Access
- 7 January 2016
- journal article
- research article
- Published by Oxford University Press (OUP) in Neuro-Oncology Practice
- Vol. 3 (4), 281-289
- https://doi.org/10.1093/nop/npv065
Abstract
NF2 patients develop multiple nervous system tumors including bilateral vestibular schwannomas (VS). The tumors and their surgical treatment are associated with deafness, neurological disability, and mortality. Medical treatment with bevacizumab has been reported to reduce VS growth and to improve hearing. In addition to evaluating these effects, this study also aimed to determine other important consequences of treatment including patient-reported quality of life and the impact of treatment on surgical VS rates. Patients treated with bevacizumab underwent serial prospective MRI, audiology, clinical, CTCAE-4.0 adverse events, and NFTI-QOL quality-of-life assessments. Tumor volumetrics were classified according to the REiNs criteria and annual VS surgical rates reviewed. Sixty-one patients (59% male), median age 25 years (range, 10–57), were reviewed. Median follow-up was 23 months (range, 3–53). Partial volumetric tumor response (all tumors) was seen in 39% and 51% had stabilization of previously growing tumors. Age and pretreatment growth rate were predictors of response. Hearing was maintained or improved in 86% of assessable patients. Mean NFTI-QOL scores improved from 12.0 to 10.7 (P < .05). Hypertension was observed in 30% and proteinuria in 16%. Twelve treatment breaks occurred due to adverse events. The rates of VS surgery decreased after the introduction of bevacizumab. Treatment with bevacizumab in this large, UK-wide cohort decreased VS growth rates and improved hearing and quality of life. The potential risk of surgical iatrogenic damage was also reduced due to an associated reduction in VS surgical rates. Ongoing follow-up of this cohort will determine the long-term benefits and risks of bevacizumab treatment.Keywords
Funding Information
- NIH
- NIHR (AC12/092)
This publication has 21 references indexed in Scilit:
- Antiangiogenic Agents for Nonmalignant Brain TumorsJournal of Neurological Surgery Part B: Skull Base, 2013
- Bevacizumab for Progressive Vestibular Schwannoma in Neurofibromatosis Type 2Otology & Neurotology, 2012
- Long-term natural history of neurofibromatosis Type 2–associated intracranial tumorsJournal of Neurosurgery, 2012
- Life expectancy in hereditary cancer predisposing diseases: an observational studyJournal of Medical Genetics, 2012
- Consensus recommendations for current treatments and accelerating clinical trials for patients with neurofibromatosis type 2American Journal of Medical Genetics Part A, 2011
- Neurofibromatosis 2: A novel risk factor for hypertension?American Journal of Medical Genetics Part A, 2011
- Bevacizumab induces regression of vestibular schwannomas in patients with neurofibromatosis type 2Neuro-Oncology, 2009
- Hearing Improvement after Bevacizumab in Patients with Neurofibromatosis Type 2The New England Journal of Medicine, 2009
- Methodological issues in longitudinal studies: vestibular schwannoma growth rates in neurofibromatosis 2Journal of Medical Genetics, 2005
- Predictors of the Risk of Mortality in Neurofibromatosis 2American Journal of Human Genetics, 2002