Bevacizumab as salvage therapy for progressive brain stem gliomas.
OBJECTIVE
There is no standard of care for patients with progredient brain stem gliomas. Therefore, we report about clinical, radiological and metabolic response to anti-angiogenic treatment with bevacizumab in a series of 3 patients with gliomas involving the brain stem.


METHODS
Three patients with histologically confirmed gliomas involving the brain stem were treated with bevacizumab for tumor progression. The clinical data, histopathological findings as well as MRI and PET follow up examinations during bevacizumab therapy were retrospectively analyzed.


RESULTS
The histopathological diagnosis revealed an anaplastic astrocytoma WHO grade III in two patients and an astrocytoma WHO grade II in 1 patients with clinical and neuroradiological signs of malignization. One patient is still progression-free 97 weeks after initiation of bevacizumab therapy. Mean progression-free survival and overall survival for the other two patients after initiation of bevacizumab therapy was 34.5 weeks and 43.5 weeks. During bevacizumab therapy mean KPS improved from 60 to 80 and mean dosage of daily dexamathasone was reduced from 7.3 mg to 1.3 mg. MRI showed a decrease of T2 weighted hyperintense lesions in all patients and a decrease of contrast enhancement in two patients. (18)F-FET-PET showed a decrease of tracer uptake in all cases (mean maximum decrease: 25%).


CONCLUSIONS
In this series treatment of progressive gliomas involving the brain stem with bevacizumab resulted in an improved clinical condition of the patients as well as a reduction of the T2 weighted lesions and reduced amino acid uptake in the tumor area. It therefore may represent a therapeutic salvage option for this type of tumor.
Department of Neurosurgery, Division of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg im Breisgau, Germany. thomas.reithmeier@uniklinik-freiburg.de
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T
Reithmeier
W O Contreras
WO
Lopez
T S
TS
Spehl
T
T
Nguyen
I
I
Mader
G
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Nikkhah
M O
MO
Pinsker
D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001254:Astrocytoma / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D000068258:Bevacizumab; D020295:Brain Stem Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology*; D003131:Combined Modality Therapy; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D020233:Gait Disorders, Neurologic / Q000209:etiology; D005910:Glioma / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D016879:Salvage Therapy / Q000379:methods*
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000068258:Bevacizumab