Abstract Details

Title Treatment of Cerebral Radiation Necrosis with Bevacizumab: The Cleveland Clinic Experience

Topic Neuro-oncology

Presentation(s) IN10 - (-)

Poster/Presentation
Number 003

Objective

Background Cerebral radiation necrosis is a devastating complication of radiation therapy of brain tumors. Recent studies have explored the role of bevacizumab, a humanized monoclonal antibody directed against vascular endothelial growth factor in the treatment of radiation necrosis of the brain. We report twenty patients with cerebral radiation necrosis who were treated with bevacizumab.

Design/Methods Twenty patients diagnosed with cerebral radiation necrosis and treated with bevacizumab between July 2007 and January 2011 were identified from the Cleveland Clinic Brain Tumor and Neuro-Oncology Center's database. Pre- and post-treatment magnetic resonance imaging (MRI) studies were compared to evaluate bevacizumab efficacy.

Results Post-treatment MRI demonstrated a radiographic response in all patients on the fluid-attenuated inversion-recovery (FLAIR) sequences and 19 of 20 patients showed improvement in the T1-weighted post-Gadolinium contrast images. The average area change in the T1-weighted post-Gadolinium contrast abnormalities was a decrease of 50.3%, and the average change in the FLAIR images was a decrease of 51.8% (using McDonald criteria). There was a mean daily dose reduction of 9.6 mg of dexamethasone after initiation of bevacizumab in patients who were on steroids at the start of bevaciuzmab therapy for radiation necrosis.

Conclusions Bevacizumab reduced cerebral edema in radiographic imaging and demonstrated a clinical benefit in patients with cerebral radiation necrosis. Bevacizumab may be onsidered as a therapeutic option in cases that do not respond to traditional corticosteroid therapy.

Authors/Disclosures
Glen H. Stevens, DO, PhD, FAAN (Cleveland Clinic Foundation) PRESENTER	The institution of Dr. Stevens has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Stevens has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO. The institution of Dr. Stevens has received research support from National Cancer Institute.
Joseph M. Palumbo, MD (BioVie)	Dr. Palumbo has received personal compensation for serving as an employee of BioVie. An immediate family member of Dr. Palumbo has received personal compensation for serving as an employee of Merck Research Laboratories. Dr. Palumbo has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stalicla SA. Dr. Palumbo has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Psychae Therapeutics Pty Ltd. Dr. Palumbo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Phocus Pharmaceuticals Inc.. Dr. Palumbo has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for BioVie. Dr. Palumbo has stock in BioVie. An immediate family member of Dr. Palumbo has stock in Merck Research Laboratories. The institution of Dr. Palumbo has received research support from United States Department of Defense. Dr. Palumbo has received intellectual property interests from a discovery or technology relating to health care. Dr. Palumbo has received intellectual property interests from a discovery or technology relating to health care. Dr. Palumbo has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
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Steven S. Rosenfeld, MD, PhD (The Neurological Institute of New York)	No disclosure on file
Jeremy N. Rich, MD (University of Pittsburgh)	No disclosure on file
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