J Neurol Surg B Skull Base 2019; 80(05): 540-546
DOI: 10.1055/s-0038-1676628
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Long-Term Effects of Bevacizumab on Vestibular Schwannoma Volume in Neurofibromatosis Type 2 Patients

Daniel E. Killeen
1   Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Laura Klesse
2   Department of Pediatrics and Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Anthony M. Tolisano
1   Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Jacob B. Hunter
1   Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Joe Walter Kutz Jr
1   Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
› Author Affiliations

Funding None.
Further Information

Publication History

10 August 2018

30 October 2018

Publication Date:
17 December 2018 (online)

Preview

Abstract

Introduction Bevacizumab offers a medical treatment that may slow the growth of vestibular schwannomas (VS) and possibly preserve hearing in patients with neurofibromatosis type 2 (NF2). This study aims to investigate the effect of long-term bevacizumab treatment on VS progression.

Methods Demographic, clinical, audiometric, and radiographic data were collected from the medical records of NF2 patients treated with bevacizumab at a tertiary medical center.

Results Eleven tumors from seven NF2 patients treated with bevacizumab were analyzed. The median age was 17 years (range: 12–47 years). Median bevacizumab treatment time was 33 months (range: 12–74 months). Of five patients with serviceable hearing pretreatment, one (20%) maintained serviceable hearing during bevacizumab therapy. Significantly slower growth rates for both tumor diameters and tumor volumes were identified during active bevacizumab treatment. Median tumor diameters and volumes during active bevacizumab treatment were 0 cm/year (range: –0.13–0.17 cm/year) and 0.1 cm3/year (range: –0.92–0.41), compared with 0.37 cm/year (range: 0–1.5 cm/year, p = 0.0011) and 1.38 cm3/year (range: 0.013–3.74), respectively, without bevacizumab treatment (p = 0.0263). Reduced tumor progression was noted with bevacizumab treatment utilizing both linear greatest diameter (hazard ratio 0.16, p = 0.006) and segmentation volumes (hazard ratio 0.15, p = 0.023). Complications of bevacizumab treatment included fatigue (43%), nausea/vomiting (43%), hypertension (43%), epistaxis (29%), and proteinuria (29%). One subject had a cerebrovascular accident detected on screening magnetic resonance imaging without symptoms or neurological sequelae.

Discussion Bevacizumab may reduce tumor growth rate and the risk of progression based on both volumetric and linear measurements.

IRB

This project was approved and in compliance with University of Texas Southwestern Medical Center IRB (122016–038).


Authorship Participation

Study design: Killeen, Tolisano, Hunter, Kutz


Data acquisition: Killeen, Hunter


Data Analysis: Killeen, Tolisano, Hunter, Kutz


Manuscript drafting: Killeen, Tolisano, Hunter, Kutz


Critical Revisions: Killeen, Klesse, Tolisano, Hunter, Kutz