Bevacizumab May Treat Refractory Brain Edema

A retrospective Chinese study of 59 people with brain edema related to metastatic cancer finds that bevacizumab (Avastin) is an effective and relatively safe treatment for brain edema, with a low risk for cerebral hemorrhage. Researchers note that their study is the most comprehensive study, with a relatively large population, in this treatment area, and that it may have significant clinical implications in salvage therapy and management for this patient population.

Xiangying Meng and colleagues treated 59 patients with metastatic cancer who had refractory brain edema with bevacizumab between March 2009 and December 2015. They report that 84.74% improved the day after treatment with bevacizumab, which is currently approved to treat colorectal, lung, glioblastoma, kidney, cervical, and ovarian cancers. A bevacizumab biosimilar, Mvasi, was approved by the FDA in September 2017.

Brain tumors are often surrounded by extensive peritumoral brain edema (PTBE), which causes neurological symptoms, including dizziness and headaches. There are several existing treatments to relieve brain edema, but the effects are often limited in some patients with refractory edema.

Researchers hypothesized that because vascular endothelial growth factor A (VEGF-A) plays an important role in causing cerebral edema associated with metastatic tumors, the monoclonal antibody bevacizumab, which works against VEGF-A, could provide an effective treatment for brain edema associated with metastatic cancer.

Magnetic resonance imaging (MRI) was performed 2 months before and again 2 months after bevacizumab treatment. Tumor and edema volumes were measured separately. The primary sites of tumor were glioma, lung, and breast. Fifteen of the 59 patients (25.4%) received concurrent brain radiotherapy. The treatment regimen of bevacizumab was adjusted depending on individual patients’ neurological symptoms. Treatment was administered a median time of once (range, 1 to 4 times), with intervals of 2 to 12 weeks between treatments.

Clinical symptoms in 50 of the 59 patients improved the day after bevacizumab treatment, and edema volumes were reduced in 55 cases. Average edema volume was significantly reduced after bevacizumab treatment from 125,583.43 ±14,093.27 to 71,613.42 ±9473.42 mm³ (P <0.01), and average edema index was significantly reduced from 25.66 ±11.54 to 17.87 ±6.87 (P <0.01).

Furthermore, the researchers report, in the group of 44 patients who did not undergo radiation, PTBE was also significantly reduced by bevacizumab treatment (P <0.01).

The main adverse event observed was hypertension, which was seen in 18.6% of patients. The researchers report that hypertension was successfully treated in all cases using antihypertensive medications. 1 patient death was reported, and was attributed to a hemorrhage of a cancerous ulcer of the maxillary sinus.