Why the study?
A four-infusion bevacizumab protocol effectively treats cerebral radiation injury but is costly and risks severe complications, motivating investigation of a single-shot approach.
Does single-shot bevacizumab improve outcomes in patients with cerebral radiation injury?
Does single-shot bevacizumab improve outcomes in patients with cerebral radiation injury?
Single-shot bevacizumab shows meaningful initial activity in reducing edema and steroid requirements for cerebral radiation injury, though durable control is rarely achieved.
Single-shot bevacizumab may reduce edema and steroid use in radiation injury; leaves open durable efficacy versus standard four-infusion regimens.
BACKGROUND: Cerebral radiation injury, including subacute radiation reactions and later stage radiation necrosis, is a severe side effect of brain tumor radiotherapy. A protocol of four infusions of the monoclonal antibody bevacizumab has been shown to be a highly effective treatment. However, bevacizumab is costly and can cause severe complications including thrombosis, bleeding and gastrointestinal perforations. METHODS: We performed a retrospective analysis of patients treated in our clinic for cerebral radiation injury who received only a singular treatment with bevacizumab. Single-shot was defined as a singular administration of bevacizumab without a second administration during an interval of at least 6 weeks. RESULTS: We identified 11 patients who had received a singular administration of bevacizumab to treat cerebral radiation injury. Prior radiation had been administered to treat gliomas (ten patients) or breast cancer brain metastases (one patient). 9 of 10 patients with available MRIs showed a marked reduction of edema at first follow-up. Discontinuation of Dexamethasone was possible in 6 patients and a significant dose reduction could be achieved in all other patients. One patient developed pulmonary artery embolism 2 months after bevacizumab administration. The median time to treatment failure of any cause was 3 months. CONCLUSIONS: Single-shot bevacizumab therefore has meaningful activity in cerebral radiation injury, but durable control is rarely achieved. In patients where a complete protocol of four infusions with bevacizumab is not feasible due to medical contraindications or lack of reimbursement, single-shot bevacizumab treatment may be considered.
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Voß et al. (2021) studied this question.
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