Antiangiogenic agents for nonmalignant brain tumors.
Objective To assess the treatment response and side effects for the use of antiangiogenic agents such as vascular endothelial growth factor (VEGF) inhibitors for patients with vestibular schwannomas and meningiomas. Design and Methods Retrospective review of eight male and two female patients (ages 14 to 70, mean 36 years), treated with bevacizumab (9) or pazopanib (1). Six patients had neurofibromatosis type 2 (NF2) with bilateral vestibular schwannomas and meningiomas, and the four others had aggressive recurrent meningiomas. Results During treatment (range 4 to 21 months, mean 9.1) with antiangiogenic agents, two patients with an atypical meningioma and radiation necrosis had dramatic partial response, the six NF2 patients had stable or slightly improved disease, and two meningioma patients had disease progression. Hearing was stable in three of the NF2 patients and was improved in three NF2 patients (one of whom received a cochlear implant). Minor toxicities included epistaxis, nausea, diarrhea, weight loss, and abdominal pain. No grade 3 or 4 toxicities were observed. Conclusion Antiangiogenic agents appear to be safe for the treatment of patients with nonmalignant brain tumors, and in select cases may be efficacious.
Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
Ammar H
AH
Hawasli
Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA ; Department of Anatomy and Neurobiology, Washington University School of Medicine, Saint Louis, Missouri, USA.
Joshua B
JB
Rubin
Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA.
David D
DD
Tran
Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA.
Douglas R
DR
Adkins
J. B. & Greeta B. Arthur Cancer Center, Mexico, Missouri, USA.
Shahid
S
Waheed
Department of Otolaryngology, Washington University School of Medicine, Saint Louis, Missouri, USA ; Department of Anatomy and Neurobiology, Washington University School of Medicine, Saint Louis, Missouri, USA.
Timothy E
TE
Hullar
Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA.
David H
DH
Gutmann
Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
John
J
Evans
Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
Jeffrey R
JR
Leonard
Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
Gregory J
GJ
Zipfel
Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
Michael R
MR
Chicoine
bevacizumab; brain tumor; meningioma; neurofibromatosis; pazopanib; vascular endothelial growth factor; vestibular schwannoma