Bevacizumab in refractory higher-grade and atypical meningioma: the current state of affairs

Expert Opin Biol Ther. 2019 Feb;19(2):99-104. doi: 10.1080/14712598.2019.1559292. Epub 2018 Dec 17.

Abstract

Introduction: Historically, systemic agents had shown limited efficacy in meningioma, at the expense of significant pharmacologic and/or financial toxicity. As meningiomas are highly vascularized, they might derive benefit from antiangiogenic therapy.

Areas covered: This review summarizes the literature regarding bevacizumab pharmacology, safety and efficacy in patients with refractory meningioma. We have searched PubMed/Medline database for pertinent articles published from inception to 1 September 2018.

Expert commentary: Results of two prospective phase II trials, supported by several retrospective cohorts, suggest a clinical benefit for the vascular endothelial growth factor inhibitor bevacizumab in meningiomas refractory to surgery and radiation therapy. This agent has a tolerable toxicity profile and seems more effective in higher-grade histologies and atypical meningioma, although responses in low-grade meningiomas have also been documented. Our conclusions are restricted due to a small size and lack of control in the prospective trials as well as the retrospective design of other studies. Further study of bevacizumab in refractory higher-grade meningiomas seems warranted.

Keywords: Bevacizumab; angiogenesis; meningioma; refractory; vascular endothelial growth factor/receptor (VEGF/R).

Publication types

  • Review

MeSH terms

  • Angiogenesis Inhibitors / adverse effects
  • Angiogenesis Inhibitors / therapeutic use
  • Bevacizumab / adverse effects
  • Bevacizumab / therapeutic use*
  • Clinical Trials, Phase II as Topic
  • Humans
  • Meningeal Neoplasms / drug therapy*
  • Meningeal Neoplasms / genetics
  • Meningeal Neoplasms / metabolism
  • Meningioma / drug therapy*
  • Meningioma / genetics
  • Meningioma / metabolism
  • Prospective Studies
  • Retrospective Studies
  • Vascular Endothelial Growth Factor A / genetics
  • Vascular Endothelial Growth Factor A / metabolism

Substances

  • Angiogenesis Inhibitors
  • Vascular Endothelial Growth Factor A
  • Bevacizumab