Abstract Details

Title Cerebrovascular Events in Glioma Patients Treated with Bevacizumab

Topic Neuro-oncology

Presentation(s) P07 - (-)

Poster/Presentation
Number 013

Objective

Background BACKGROUND: Bevacizumab, a humanized monoclonal anti-vascular endothelial growth factor antibody, is approved for progressive glioblastoma. Phase II clinical trials suggested an increased risk of ischemic stroke (IS) and intracranial hemorrhage (ICH) while on bevacizumab; however, data regarding the incidence, clinical characteristics, and neuroimaging of glioma patients on treatment is lacking.

Design/Methods DESIGN/METHODS: A retrospective review of glioma patients on bevacizumab at our institution July 2005 to June 2011 was studied. Patients with MRI-confirmed IS and/or ICH while on bevacizumab was investigated and compared to historical data. Demographics, vascular risk factors, clinical presentations, tumor characteristics, and tumor treatment plans were collected.

Results RESULTS: A total of 162 patients (65% male) received bevacizumab and 23 (14%) developed a cerebrovascular event while on treatment, with 3 (2%) IS and 20 (12%) ICH. All IS and ICH patients received prior brain radiation. In the IS group, 2 (66%) patients were symptomatic, with 1 (33%) cardiembolic and 2 (66%) lacunar strokes. None had risk factors besides hypercoagulable state from malignancy. In the ICH group, 3 (15%) patients had a symptomatic bleed and 6 (30%) had associated hypertension. All ICHs were intratumoral and 16 (80%) associated with tumor progression. Median survival after stroke was 9.8 and 3.7 months in the IS and ICH groups, respectively. Length of bevacizumab treatment was not significantly associated with development of IS (p=0.6) and ICH (p=0.3).

Conclusions CONCLUSIONS: In our study, 78% of strokes were asymptomatic and diagnosed on serial imaging. ICHs were more common, but all were small intratumoral bleeds, mostly seen during tumor progression. Development of cerebrovascular events was not associated with duration of bevacizumab treatment. Our study cannot determine causality and randomized controlled studies are needed to assess the risk of IS and ICH with bevacizumab.

Authors/Disclosures
Donika K. Patel, DO (LeBauer Neurology) PRESENTER	No disclosure on file
Tung Tran, MD (Duke University Medical Center)	No disclosure on file
Seby John, MD (Cleveland Clinic Abu Dhabi)	Dr. John has nothing to disclose.
	No disclosure on file
	No disclosure on file

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