Martin Voss1,2,3,4, Katharina J Wenger5,6,7,8, Emmanouil Fokas5,6,7,9, Marie-Thérèse Forster5,6,7,10, Joachim P Steinbach11,5,6,7, Michael W Ronellenfitsch11,5,6,7. 1. Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. martin.voss@kgu.de. 2. University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. martin.voss@kgu.de. 3. German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt/Main, Germany. martin.voss@kgu.de. 4. Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany. martin.voss@kgu.de. 5. University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. 6. German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt/Main, Germany. 7. Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany. 8. Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. 9. Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. 10. Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. 11. Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.
Abstract
BACKGROUND: Cerebral radiation injury, including subacute radiation reactions and later stage radiation necrosis, is a severe side effect of brain tumor radiotherapy. A protocol of four infusions of the monoclonal antibody bevacizumab has been shown to be a highly effective treatment. However, bevacizumab is costly and can cause severe complications including thrombosis, bleeding and gastrointestinal perforations. METHODS: We performed a retrospective analysis of patients treated in our clinic for cerebral radiation injury who received only a singular treatment with bevacizumab. Single-shot was defined as a singular administration of bevacizumab without a second administration during an interval of at least 6 weeks. RESULTS: We identified 11 patients who had received a singular administration of bevacizumab to treat cerebral radiation injury. Prior radiation had been administered to treat gliomas (ten patients) or breast cancer brain metastases (one patient). 9 of 10 patients with available MRIs showed a marked reduction of edema at first follow-up. Discontinuation of Dexamethasone was possible in 6 patients and a significant dose reduction could be achieved in all other patients. One patient developed pulmonary artery embolism 2 months after bevacizumab administration. The median time to treatment failure of any cause was 3 months. CONCLUSIONS: Single-shot bevacizumab therefore has meaningful activity in cerebral radiation injury, but durable control is rarely achieved. In patients where a complete protocol of four infusions with bevacizumab is not feasible due to medical contraindications or lack of reimbursement, single-shot bevacizumab treatment may be considered.
BACKGROUND:Cerebral radiation injury, including subacute radiation reactions and later stage radiation necrosis, is a severe side effect of brain tumor radiotherapy. A protocol of four infusions of the monoclonal antibody bevacizumab has been shown to be a highly effective treatment. However, bevacizumab is costly and can cause severe complications including thrombosis, bleeding and gastrointestinal perforations. METHODS: We performed a retrospective analysis of patients treated in our clinic for cerebral radiation injury who received only a singular treatment with bevacizumab. Single-shot was defined as a singular administration of bevacizumab without a second administration during an interval of at least 6 weeks. RESULTS: We identified 11 patients who had received a singular administration of bevacizumab to treat cerebral radiation injury. Prior radiation had been administered to treat gliomas (ten patients) or breast cancer brain metastases (one patient). 9 of 10 patients with available MRIs showed a marked reduction of edema at first follow-up. Discontinuation of Dexamethasone was possible in 6 patients and a significant dose reduction could be achieved in all other patients. One patient developed pulmonary artery embolism 2 months after bevacizumab administration. The median time to treatment failure of any cause was 3 months. CONCLUSIONS: Single-shot bevacizumab therefore has meaningful activity in cerebral radiation injury, but durable control is rarely achieved. In patients where a complete protocol of four infusions with bevacizumab is not feasible due to medical contraindications or lack of reimbursement, single-shot bevacizumab treatment may be considered.
Entities:
Keywords:
Bevacizumab; Dexamethasone; Edema; Radiation necrosis; Side effect
Authors: Hans Urban; Eike Steidl; Elke Hattingen; Katharina Filipski; Markus Meissner; Martin Sebastian; Agnes Koch; Adam Strzelczyk; Marie-Thérèse Forster; Peter Baumgarten; Michael W Ronellenfitsch; Joachim P Steinbach; Martin Voss Journal: Front Immunol Date: 2022-01-03 Impact factor: 7.561