title: Effect of bevacizumab on intracranial meningiomas in patients with neurofibromatosis type 2 - a retrospective case series.
abstract: OBJECTIVE
  The hallmark of neurofibromatosis type 2 (NF2) is bilateral vestibular schwannomas (VS). Approximately 80% of NF2 patients also have intracranial meningiomas. Vascular endothelial growth factor (VEGF) is expressed in both NF2-related and sporadic occurring meningiomas and anti-VEGF therapy (bevacizumab) may, therefore, be beneficial in NF2-related meningiomas. The purpose of the study was to report the effect of bevacizumab on meningiomas in NF2 patients.
  
  
  METHODS
  We retrospectively reviewed the effect of bevacizumab on the cross-sectional area (CSA) of 14 intracranial meningiomas in 7 NF2 patients. Bevacizumab 10 mg/kg was administered intravenously every two weeks for six months and 15 mg/kg every three weeks thereafter. Patients were evaluated according to the modified Macdonald criteria with repeated magnetic resonance (MR) scans.
  
  
  RESULTS
  The median duration of therapy was 27 months (range 16-34) and 42 MR scans (median 8, range 4-11) were reviewed. The median annual change in meningioma CSA prior to bevacizumab was 2% (range -4%-+76%). During treatment, a decrease in meningioma CSA was observed in 5 of 14 meningiomas (36%) in 5 of 7 patients (71%). The median decrease in CSA was -10% (range -3%--25%). One meningioma (7%) progressed and the remaining (93%) had stable disease.
  
  
  CONCLUSIONS
  Bevacizumab may slow or reverse the growth of some NF-related meningiomas. However, we have previously reported a fatal case of intracerebral hemorrhage following bevacizumab in NF2 patients, wherefore, this effect needs to be balanced carefully against the risk of side effects.
authors.affiliation: a Department of Otolaryngology - Head and Neck Surgery and Audiology , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Mikkel Christian
authors.initials: MC
authors.lastname: Alanin
authors.affiliation: b Department of Radiology , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Camilla
authors.initials: C
authors.lastname: Klausen
authors.affiliation: a Department of Otolaryngology - Head and Neck Surgery and Audiology , Copenhagen University Hospital , Copenhagen , Denmark.|e Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Caye-Thomasen
authors.affiliation: b Department of Radiology , Copenhagen University Hospital , Copenhagen , Denmark.|e Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Thomsen
authors.affiliation: c Department of Neurosurgery , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Kaare
authors.initials: K
authors.lastname: Fugleholm
authors.affiliation: c Department of Neurosurgery , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Poulsgaard
authors.affiliation: d Department of Oncology and Radiotherapy , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Lassen
authors.affiliation: d Department of Oncology and Radiotherapy , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Mau-Sorensen
authors.affiliation: d Department of Oncology and Radiotherapy , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Kenneth Francis
authors.initials: KF
authors.lastname: Hofland
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D008579:Meningioma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D016518:Neurofibromatosis 2 / Q000150:complications*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab
keywords: Macdonald criteria; VEGF; avastin; bevacizumab; meningiomas; neurofibromatosis