Bevacizumab for progressive vestibular schwannoma in neurofibromatosis type 2: a retrospective review of 31 patients.

Abstract

OBJECTIVE:

Early studies suggest that bevacizumab treatment can result in tumor shrinkage and hearing improvement for some patients with neurofibromatosis type 2 (NF2). The aim of this study was to report extended follow-up in a larger cohort of similarly treated patients.

STUDY DESIGN:

Retrospective study.

SETTING:

Tertiary referral center

PATIENTS:

Thirty-one consecutive NF2 patients who received bevacizumab for progressive vestibular schwannomas.

MAIN OUTCOME MEASURE:

Hearing improvement, defined as an improvement in word recognition score above the 95% critical difference compared with baseline, and radiographic response, defined as a 20% or greater decrease in tumor volume compared with baseline.

RESULTS:

The median age was 26 years (range, 12-73 yr). The median volumetric tumor growth rate before treatment was 64% per year. At the time of analysis, the median duration of treatment was 14 months (range, 6-41 mo) with a total of 47 patient-years of follow-up. A hearing response occurred in 57% (13/23) of evaluable patients and a radiographic response in 55% (17/31) of target vestibular schwannomas. The median time to response was 3 months for both end points. The only clinical or radiographic feature at baseline that correlated with change in tumor volume at 3 months was the mean apparent diffusion coefficient value, a radiologic marker of edema (p = 0.036). Ninety percent of patients had stable or improved hearing after 1 year of treatment and 61% at 3 years; 88% of patients had stable or decreased tumor size after 1 year of treatment and 54% at 3 years. Overall, treatment was well tolerated.

CONCLUSION:

Bevacizumab treatment was followed by hearing improvement and tumor shrinkage in more than 50% of progressive vestibular schwannomas in NF2 patients. Stable or improved hearing was retained in the majority of patients.

• Authors: Scott R Plotkin, Vanessa L Merker, Chris Halpin, Dominique Jennings, Michael J McKenna, Gordon J Harris, Fred G Barker 2nd
• Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Otol Neurotol) Vol. 33 Issue 6 Pg. 1046-52 (Aug 2012) ISSN: 1537-4505 [Electronic] United States
• PMID: 22805104 (Publication Type: Journal Article)

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Vascular Endothelial Growth Factor A
• Bevacizumab

Topics

• Adolescent
• Adult
• Aged
• Angiogenesis Inhibitors (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
• Audiometry, Pure-Tone
• Bevacizumab
• Child
• Disease Progression
• Female
• Follow-Up Studies
• Hearing Loss (etiology, prevention & control)
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neurofibromatosis 2 (complications)
• Neuroma, Acoustic (drug therapy, etiology)
• Retrospective Studies
• Treatment Outcome
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Young Adult