Atypical and anaplastic (WHO Grades II and III)
meningiomas are aggressive
tumors, and patients often progress despite surgery and radiation. There is no known effective chemotherapeutic option for these patients.
Meningiomas have a high expression of
vascular endothelial growth factor receptor (VEGFR). We sought to retrospectively study the activity of
bevacizumab, which is an anti-angiogenic agent targeting the
VEGF pathway in these
tumors. This is a retrospective review of WHO Grade II and III
meningiomas treated at four institutions, selecting only those patients who received
bevacizumab. We analyzed radiographic response according to standard RANO criteria, progression-free survival (PFS) and overall survival from the initiation of
bevacizumab therapy using Kaplan-Meier statistics. We identified 15 patients across four institutions who carried a diagnosis of atypical or anaplastic
meningioma and were treated with
bevacizumab. Best radiographic response was stable disease. MR perfusion studies showed decreased
tumor blood volume in one patient. Three patients developed non-fatal intratumoral
hemorrhage. Median PFS was 26 weeks (95 % CI, 10-29 weeks). Six month PFS rate was 43.8 % (95 % CI, 15.7-69.1 %).
Bevacizumab was well-tolerated in our patients, and may be considered in patients who have exhausted radiation and surgical options. Prospective studies are required to define the safety and efficacy of
bevacizumab in atypical and anaplastic
meningiomas.