Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2

a systematic review and meta-analysis of treatment outcomes

Victor M. Lu, Krishnan Ravindran, Christopher S. Graffeo, Avital Perry, Jamie J. Van Gompel, David Daniels, Michael J. Link

Research output: Contribution to journalReview article

Abstract

Background: Individual evidence suggests that the anti-angiogenic agent bevacizumab may control vestibular schwannoma (VS) growth and promote hearing preservation in patients with neurofibromatosis type 2 (NF2). However, such metadata has yet to be consolidated, as well as its side-effect profile yet to be fully understood. Our aim was to pool systematically-identified metadata in the literature and substantiate the clinical efficacy and safety of bevacizumab with respect to radiographic tumor response, hearing, and treatment outcomes. Methods: Searches of seven electronic databases from inception to March 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidence of outcomes was then extracted and pooled by random-effects meta-analysis of proportions. Results: Eight articles reporting 161 NF2 patients with 196 assessable VS met satisfied all criteria. Radiographic response to bevacizumab was partial regression in 41% (95% CI 31–51%), no change in 47% (95% CI 39–55%), and tumor progression in 7% (95% CI 1–15%). In patients with assessable audiometric data, bevacizumab treatment resulted in hearing improvement in 20% (95% CI 9–33%), stability in 69% (95% CI 51–85%) and additional loss in 6% (95% CI 1–15%) Serious bevacizumab toxicity was observed in 17% (95% CI 10–26%). Subsequent surgical intervention was required in 11% (95% CI 2–20%). Conclusions: Bevacizumab may arrest both tumor progression and hearing loss in select NF2 patients presenting with VS lesions. However, a considerable proportion of patients are anticipated to experience serious adverse events; correspondingly, judicious use of bevacizumab for symptomatic management of VS in NF2 is recommended.

Original languageEnglish (US)
JournalJournal of neuro-oncology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Neurofibromatosis 2
Acoustic Neuroma
Meta-Analysis
Safety
Hearing
Neoplasms
Bevacizumab
Hearing Loss
Databases
Guidelines
Incidence
Growth

Keywords

  • Avastin
  • Bevacizumab
  • Neurofibromatosis type 2
  • NF2
  • Schwannoma

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2 : a systematic review and meta-analysis of treatment outcomes. / Lu, Victor M.; Ravindran, Krishnan; Graffeo, Christopher S.; Perry, Avital; Van Gompel, Jamie J.; Daniels, David; Link, Michael J.

In: Journal of neuro-oncology, 01.01.2019.

Research output: Contribution to journalReview article

Lu, Victor M. ; Ravindran, Krishnan ; Graffeo, Christopher S. ; Perry, Avital ; Van Gompel, Jamie J. ; Daniels, David ; Link, Michael J. / Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2 : a systematic review and meta-analysis of treatment outcomes. In: Journal of neuro-oncology. 2019.
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title = "Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2: a systematic review and meta-analysis of treatment outcomes",
abstract = "Background: Individual evidence suggests that the anti-angiogenic agent bevacizumab may control vestibular schwannoma (VS) growth and promote hearing preservation in patients with neurofibromatosis type 2 (NF2). However, such metadata has yet to be consolidated, as well as its side-effect profile yet to be fully understood. Our aim was to pool systematically-identified metadata in the literature and substantiate the clinical efficacy and safety of bevacizumab with respect to radiographic tumor response, hearing, and treatment outcomes. Methods: Searches of seven electronic databases from inception to March 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidence of outcomes was then extracted and pooled by random-effects meta-analysis of proportions. Results: Eight articles reporting 161 NF2 patients with 196 assessable VS met satisfied all criteria. Radiographic response to bevacizumab was partial regression in 41{\%} (95{\%} CI 31–51{\%}), no change in 47{\%} (95{\%} CI 39–55{\%}), and tumor progression in 7{\%} (95{\%} CI 1–15{\%}). In patients with assessable audiometric data, bevacizumab treatment resulted in hearing improvement in 20{\%} (95{\%} CI 9–33{\%}), stability in 69{\%} (95{\%} CI 51–85{\%}) and additional loss in 6{\%} (95{\%} CI 1–15{\%}) Serious bevacizumab toxicity was observed in 17{\%} (95{\%} CI 10–26{\%}). Subsequent surgical intervention was required in 11{\%} (95{\%} CI 2–20{\%}). Conclusions: Bevacizumab may arrest both tumor progression and hearing loss in select NF2 patients presenting with VS lesions. However, a considerable proportion of patients are anticipated to experience serious adverse events; correspondingly, judicious use of bevacizumab for symptomatic management of VS in NF2 is recommended.",
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T1 - Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2

T2 - a systematic review and meta-analysis of treatment outcomes

AU - Lu, Victor M.

AU - Ravindran, Krishnan

AU - Graffeo, Christopher S.

AU - Perry, Avital

AU - Van Gompel, Jamie J.

AU - Daniels, David

AU - Link, Michael J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Individual evidence suggests that the anti-angiogenic agent bevacizumab may control vestibular schwannoma (VS) growth and promote hearing preservation in patients with neurofibromatosis type 2 (NF2). However, such metadata has yet to be consolidated, as well as its side-effect profile yet to be fully understood. Our aim was to pool systematically-identified metadata in the literature and substantiate the clinical efficacy and safety of bevacizumab with respect to radiographic tumor response, hearing, and treatment outcomes. Methods: Searches of seven electronic databases from inception to March 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidence of outcomes was then extracted and pooled by random-effects meta-analysis of proportions. Results: Eight articles reporting 161 NF2 patients with 196 assessable VS met satisfied all criteria. Radiographic response to bevacizumab was partial regression in 41% (95% CI 31–51%), no change in 47% (95% CI 39–55%), and tumor progression in 7% (95% CI 1–15%). In patients with assessable audiometric data, bevacizumab treatment resulted in hearing improvement in 20% (95% CI 9–33%), stability in 69% (95% CI 51–85%) and additional loss in 6% (95% CI 1–15%) Serious bevacizumab toxicity was observed in 17% (95% CI 10–26%). Subsequent surgical intervention was required in 11% (95% CI 2–20%). Conclusions: Bevacizumab may arrest both tumor progression and hearing loss in select NF2 patients presenting with VS lesions. However, a considerable proportion of patients are anticipated to experience serious adverse events; correspondingly, judicious use of bevacizumab for symptomatic management of VS in NF2 is recommended.

AB - Background: Individual evidence suggests that the anti-angiogenic agent bevacizumab may control vestibular schwannoma (VS) growth and promote hearing preservation in patients with neurofibromatosis type 2 (NF2). However, such metadata has yet to be consolidated, as well as its side-effect profile yet to be fully understood. Our aim was to pool systematically-identified metadata in the literature and substantiate the clinical efficacy and safety of bevacizumab with respect to radiographic tumor response, hearing, and treatment outcomes. Methods: Searches of seven electronic databases from inception to March 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidence of outcomes was then extracted and pooled by random-effects meta-analysis of proportions. Results: Eight articles reporting 161 NF2 patients with 196 assessable VS met satisfied all criteria. Radiographic response to bevacizumab was partial regression in 41% (95% CI 31–51%), no change in 47% (95% CI 39–55%), and tumor progression in 7% (95% CI 1–15%). In patients with assessable audiometric data, bevacizumab treatment resulted in hearing improvement in 20% (95% CI 9–33%), stability in 69% (95% CI 51–85%) and additional loss in 6% (95% CI 1–15%) Serious bevacizumab toxicity was observed in 17% (95% CI 10–26%). Subsequent surgical intervention was required in 11% (95% CI 2–20%). Conclusions: Bevacizumab may arrest both tumor progression and hearing loss in select NF2 patients presenting with VS lesions. However, a considerable proportion of patients are anticipated to experience serious adverse events; correspondingly, judicious use of bevacizumab for symptomatic management of VS in NF2 is recommended.

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KW - Neurofibromatosis type 2

KW - NF2

KW - Schwannoma

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