High-grade glioma before and after treatment with radiation and Avastin: initial observations

Neuro Oncol. 2008 Oct;10(5):700-8. doi: 10.1215/15228517-2008-042. Epub 2008 Aug 12.


We evaluate the effects of adjuvant treatment with the angiogenesis inhibitor Avastin (bevacizumab) on pathological tissue specimens of high-grade glioma. Tissue from five patients before and after treatment with Avastin was subjected to histological evaluation and compared to four control cases of glioma before and after similar treatment protocols not including bevacizumab. Clinical and radiographic data were reviewed. Histological analysis focused on microvessel density and vascular morphology, and expression patterns of vascular endothelial growth factor-A (VEGF-A) and the hematopoietic stem cell, mesenchymal, and cell motility markers CD34, smooth muscle actin, D2-40, and fascin. All patients with a decrease in microvessel density had a radiographic response, whereas no response was seen in the patients with increased microvessel density. Vascular morphology showed apparent "normalization" after Avastin treatment in two cases, with thin-walled and evenly distributed vessels. VEGF-A expression in tumor cells was increased in two cases and decreased in three and did not correlate with treatment response. There was a trend toward a relative increase of CD34, smooth muscle actin, D2-40, and fascin immunostaining following treatment with Avastin. Specimens from four patients with recurrent malignant gliomas before and after adjuvant treatment (not including bevacizumab) had features dissimilar from our study cases. We conclude that a change in vascular morphology can be observed following antiangiogenic treatment. There seems to be no correlation between VEGF-A expression and clinical parameters. While the phenomena we describe may not be specific to Avastin, they demonstrate the potential of tissue-based analysis for the discovery of clinically relevant treatment response biomarkers.

MeSH terms

  • Actins / drug effects
  • Actins / radiation effects
  • Adult
  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized
  • Antigens, CD34 / drug effects
  • Antigens, CD34 / radiation effects
  • Bevacizumab
  • Brain Neoplasms / drug therapy*
  • Brain Neoplasms / pathology
  • Brain Neoplasms / radiotherapy*
  • Carrier Proteins / drug effects
  • Carrier Proteins / radiation effects
  • Combined Modality Therapy
  • Female
  • Glioma / drug therapy*
  • Glioma / pathology
  • Glioma / radiotherapy*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Microfilament Proteins / drug effects
  • Microfilament Proteins / radiation effects
  • Middle Aged
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / radiotherapy
  • Retrospective Studies
  • Vascular Endothelial Growth Factor A / drug effects
  • Vascular Endothelial Growth Factor A / radiation effects


  • Actins
  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antigens, CD34
  • Carrier Proteins
  • Microfilament Proteins
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • fascin
  • Bevacizumab