The Role of Bevacizumab for Recalcitrant Intracranial Meningiomas: A Single Institution's Experience and a Systematic Review of the Literature

Introduction: Meningiomas account for over 30% of all primary brain tumors. While surgery can be curative for these tumors, several factors, including higher histological grade and a higher Simpson grade of resection, may lead to a higher likelihood of recurrence. For recurrent meningiomas, particularly if additional radiation and microsurgical resection options have been exhausted, bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, may be considered as a therapeutic agent. However, the literature regarding the effects of bevacizumab for patients with meningioma recurrences is sparse. Thus, we present a systematic review of the literature and case series of patients from our institution with recalcitrant meningiomas who were subsequently treated with bevacizumab.

Methods: Patients at our institution who were diagnosed with recurrent meningioma between January 2000 and September 2020 and received bevacizumab monotherapy were included in this study. Those who had a diagnosis of neurofibromatosis or no documentation of compliance with bevacizumab monotherapy in the electronic health record were excluded. Bevacizumab monotherapy duration and dosages were noted, as well as progression-free survival (PFS) after first bevacizumab injection. A systematic review of the literature was also performed.

Results: A total of 23 patients qualified for inclusion in this study. There were 13 men and 10 women with a median age of 55 years at initial diagnosis. When bevacizumab was administered, 2 patient had a WHO grade I meningioma, 10 patients had meningiomas that were deemed WHO grade II, and 11 patients had WHO grade III meningiomas. The median duration of bevacizumab monotherapy was 4 months and the median PFS after first bevacizumab injection was 7 months. Progression-free survival at 6 months (PFS-6) was 57%. Reported complications during bevacizumab monotherapy included hypertension (n = 3), nausea (n = 1), fatigue (n = 1), proteinuria (n = 1), bleeding (n = 1), aphasia (n = 1), anorexia (n = 1), and pulmonary embolism (n = 1). Of these patients, two were taken off bevacizumab due to hypertension and aphasia.

Conclusion: Patients with recurrent meningiomas seem to benefit marginally from treatment with bevacizumab in terms of progression free survival, but the rate of complications is not negligible. In our small series, all patients had a complicated clinical course and, despite multimodal therapy, most of them had progression of their meningioma after bevacizumab induction. Nonetheless, both in the literature and in our series, select patients seemed to have long term tumor control with bevacizumab. However, there seems to be no correlation with histological grade and tumor control. Thus, further studies are needed to identify prognostic factors that correlate with good meningioma control after bevacizumab therapy ([Fig. 1]).

Fig. 1

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022