A multi-institutional phase II trial of bevacizumab for recurrent and refractory meningioma

Authors

Priya Kumthekar, The Lou and Jean Malnati Brain Tumor Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
Sean Aaron Grimm, Department of Neurology, Rush University Medical Center, Chicago, IL, USA.
Roxanne T. Aleman, Advocate Aurora HealthFollow
Marc C. Chamberlain, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA.Follow
David Schiff, University of Virginia School of Medicine, Charlottesville, VA, USA.
Patrick Y. Wen, Dana-Farber Cancer Institute, Boston, MA, USA.
Fabio Massaiti Iwamoto, Columbia Medical Center, New York, NY, USA.
Demirkan Besim Gursel, Northwestern University, Chicago, IL, USA.
David A. Reardon, Dana-Farber Cancer Institute, Boston, MA, USA.
Benjamin Purow, University of Virginia School of Medicine, Charlottesville, VA, USA.
Masha Kocherginski, Department of Preventative Medicine, Feinberg College of Medicine at Northwestern University, Chicago, IL, USA.
Irene Helenowski, Department of Preventative Medicine, Feinberg College of Medicine at Northwestern University, Chicago, IL, USA.
Jeffrey J. Raizer, The Lou and Jean Malnati Brain Tumor Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.

Recommended Citation

Kumthekar P, Grimm SA, Aleman RT, et al. A multi-institutional phase II trial of bevacizumab for recurrent and refractory meningioma. Neurooncol Adv. 2022;4(1):vdac123. Published 2022 Aug 19. doi:10.1093/noajnl/vdac123

Affiliations

Advocate Christ Medical Center

Abstract

Background: Systemic therapies for refractory meningiomas are limited with no FDA-approved therapeutics. Vascular endothelial growth factor (VEGF) is a signaling protein associated with neovascularization, peritumoral edema, and meningioma tumorigenesis.

Methods: This phase II study investigates the efficacy of bevacizumab (BEV), a VEGF binding monoclonal antibody, in patients with progressive Grade I (G1M), Grade II (G2M), Grade III (G3M) meningioma, and other non-parenchymal tumors including vestibular schwannoma (n = 4) and hemangiopericytoma (n = 4) with the primary endpoint of progression-free survival rate at 6-months (PFS-6). Non-meningiomas were included with the respective meningioma grade in the analysis. Secondary endpoints include median overall survival (mOS) and response rate.

Results: Fifty Patients (26 women; median age 54 years; range 23-81), 42 with progressive meningioma were treated: 10 G1M, 20 G2M, and 12 G3M. Prior treatments include surgical resection (41 patients), radiosurgery (24 patients), external beam radiotherapy (28 patients), and chemotherapy (14 patients). Median infusions administered were 16 (range, 2-68). Response was graded using the Macdonald's criteria. PFS-6, median PFS, and mOS were 87%, 22 months, 35 months for G1M; 77%, 23 months, 41 months for G2M; and 46%, 8 months, 12 months for G3M. Best radiographic responses include stable disease (G1M: 100%; G2M: 85%; G3M: 82%); partial response (G1M: 0%; G2M: 5%; G3M: 0%) and progressive disease (G1M: 0%; G2M: 10%; G3M:18%). The most common toxicities were hypertension (n = 19, 42.2%), proteinuria (n = 16, 35.6%), and fatigue (n = 14, 31.1%).

Conclusion: This study showed BEV is well tolerated and appears to be a promising systemic treatment option for patients with recurrent and refractory meningiomas.

Type

Article

PubMed ID

36225651