Skip to main content

Advertisement

SpringerLink
Log in

Bevacizumab therapy for adults with recurrent/progressive meningioma: a retrospective series

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Intracranial meningiomas are often indolent tumors which typically grow over years to decades. Nonetheless, meningiomas that progress after maximum safe resection and radiation therapy pose a significant therapeutic challenge and effective therapies have yet to be identified. Preclinical studies implicate angiogenesis in the pathophysiology of more aggressive meningiomas, suggesting that anti-angiogenic therapies may be of utility in this setting. We performed a retrospective review of fourteen patients with recurrent meningioma treated at Duke University Medical Center with bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor, administered either alone or in combination with chemotherapy. Most patients were heavily pre-treated. Progression-free survival at 6 months was 86 % and was comparable regardless of meningioma grade and whether bevacizumab was administered as monotherapy or in combination with chemotherapy. Most toxicities were mild however single patients developed CNS hemorrhage (grade 1) and intestinal perforation (grade 4), respectively. Bevacizumab can be administered safely to patients with meningioma and appears to be associated with encouraging anti-tumor effect when administered as either a single agent or in combination with chemotherapy. Phase II trials investigating bevacizumab in patients with progressive/recurrent meningioma are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. CBTRUS (2010) CBTRUS: 2010 statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2004–2006

  2. Mawrin C, Perry A (2010) Pathological classification and molecular genetics of meningiomas. J Neurooncol 99:379–391. doi:10.1007/s11060-010-0342-2

    Article  PubMed  CAS  Google Scholar 

  3. Alexiou GA, Gogou P, Markoula S, Kyritsis AP (2010) Management of meningiomas. Clin Neurol Neurosurg 112:177–182. doi:10.1016/j.clineuro.2009.12.011

    Article  PubMed  Google Scholar 

  4. Wen PY, Quant E, Drappatz J, Beroukhim R, Norden AD (2010) Medical therapies for meningiomas. J Neurooncol 99:365–378. doi:10.1007/s11060-010-0349-8

    Article  PubMed  CAS  Google Scholar 

  5. Hanft S, Canoll P, Bruce JN (2010) A review of malignant meningiomas: diagnosis, characteristics, and treatment. J Neurooncol 99:433–443. doi:10.1007/s11060-010-0348-9

    Article  PubMed  CAS  Google Scholar 

  6. Mason WP, Gentili F, Macdonald DR, Hariharan S, Cruz CR, Abrey LE (2002) Stabilization of disease progression by hydroxyurea in patients with recurrent or unresectable meningioma. J Neurosurg 97:341–346. doi:10.3171/jns.2002.97.2.0341

    Article  PubMed  CAS  Google Scholar 

  7. Newton HB (2007) Hydroxyurea chemotherapy in the treatment of meningiomas. Neurosurg Focus 23:E11

    Article  PubMed  Google Scholar 

  8. Newton HB, Scott SR, Volpi C (2004) Hydroxyurea chemotherapy for meningiomas: enlarged cohort with extended follow-up. Br J Neurosurg 18:495–499

    Article  PubMed  CAS  Google Scholar 

  9. Rosenthal MA, Ashley DL, Cher L (2002) Treatment of high risk or recurrent meningiomas with hydroxyurea. J Clin Neurosci 9:156–158. doi:10.1054/jocn.2001.1019S0967586801910197

    Article  PubMed  Google Scholar 

  10. Loven D, Hardoff R, Sever ZB, Steinmetz AP, Gornish M, Rappaport ZH, Fenig E, Ram Z, Sulkes A (2004) Non-resectable slow-growing meningiomas treated by hydroxyurea. J Neurooncol 67:221–226

    Article  PubMed  Google Scholar 

  11. Schrell UM, Rittig MG, Anders M, Koch UH, Marschalek R, Kiesewetter F, Fahlbusch R (1997) Hydroxyurea for treatment of unresectable and recurrent meningiomas. II. Decrease in the size of meningiomas in patients treated with hydroxyurea. J Neurosurg 86:840–844

    Article  PubMed  CAS  Google Scholar 

  12. Wen PY, Yung WK, Lamborn KR, Norden AD, Cloughesy TF, Abrey LE, Fine HA, Chang SM, Robins HI, Fink K, Deangelis LM, Mehta M, Di Tomaso E, Drappatz J, Kesari S, Ligon KL, Aldape K, Jain RK, Stiles CD, Egorin MJ, Prados MD (2009) Phase II study of imatinib mesylate for recurrent meningiomas (North American Brain Tumor Consortium study 01-08). Neuro-oncology 11:853–860. doi:10.1215/15228517-2009-010

    Article  PubMed  CAS  Google Scholar 

  13. Norden AD, Raizer JJ, Abrey LE, Lamborn KR, Lassman AB, Chang SM, Yung WK, Gilbert MR, Fine HA, Mehta M, Deangelis LM, Cloughesy TF, Robins HI, Aldape K, Dancey J, Prados MD, Lieberman F, Wen PY (2010) Phase II trials of erlotinib or gefitinib in patients with recurrent meningioma. J Neurooncol 96:211–217. doi:10.1007/s11060-009-9948-7

    Article  PubMed  CAS  Google Scholar 

  14. Folkman J (1971) Tumor angiogenesis: therapeutic implications. N Engl J Med 285:1182–1186

    Article  PubMed  CAS  Google Scholar 

  15. Hicklin DJ, Ellis LM (2005) Role of the vascular endothelial growth factor pathway in tumor growth and angiogenesis. J Clin Oncol 23:1011–1027

    Article  PubMed  CAS  Google Scholar 

  16. Pistolesi S, Boldrini L, Gisfredi S, De Ieso K, Camacci T, Caniglia M, Lupi G, Leocata P, Basolo F, Pingitore R, Parenti G, Fontanini G (2004) Angiogenesis in intracranial meningiomas: immunohistochemical and molecular study. Neuropathol Appl Neurobiol 30:118–125

    Article  PubMed  CAS  Google Scholar 

  17. Rogers L, Gilbert M, Vogelbaum MA (2010) Intracranial meningiomas of atypical (WHO grade II) histology. J Neurooncol 99:393–405. doi:10.1007/s11060-010-0343-1

    Article  PubMed  Google Scholar 

  18. Cohen MH, Shen YL, Keegan P, Pazdur R (2009) FDA drug approval summary: bevacizumab (Avastin) as treatment of recurrent glioblastoma multiforme. Oncologist 14:1131–1138

    Google Scholar 

  19. Barresi V, Tuccari G (2009) Evaluation of neo-angiogenesis in a case of chordoid meningioma. J Neurooncol 95:445–447

    Article  PubMed  Google Scholar 

  20. Provias J, Claffey K, delAguila L, Lau N, Feldkamp M, Guha A (1997) Meningiomas: role of vascular endothelial growth factor/vascular permeability factor in angiogenesis and peritumoral edema. Neurosurgery 40:1016–1026

    Article  PubMed  CAS  Google Scholar 

  21. Maiuri F, De Caro MB, Esposito F, Cappabianca P, Strazzullo V, Pettinato G, de Divitiis E (2007) Recurrences of meningiomas: predictive value of pathological features and hormonal and growth factors. J Neurooncol 82:63–68

    Article  PubMed  Google Scholar 

  22. Otsuka S, Tamiya T, Ono Y, Michiue H, Kurozumi K, Daido S, Kambara H, Date I, Ohmoto T (2004) The relationship between peritumoral brain edema and the expression of vascular endothelial growth factor and its receptors in intracranial meningiomas. J Neurooncol 70:349–357

    Article  PubMed  Google Scholar 

  23. Yoshioka H, Hama S, Taniguchi E, Sugiyama K, Arita K, Kurisu K (1999) Peritumoral brain edema associated with meningioma: influence of vascular endothelial growth factor expression and vascular blood supply. Cancer 85:936–944

    Article  PubMed  CAS  Google Scholar 

  24. Ragel BT, Jensen RL (2010) Aberrant signaling pathways in meningiomas. J Neurooncol 99:315–324. doi:10.1007/s11060-010-0381-8

    Article  PubMed  CAS  Google Scholar 

  25. Goldman CK, Bharara S, Palmer CA, Vitek J, Tsai JC, Weiss HL, Gillespie GY (1997) Brain edema in meningiomas is associated with increased vascular endothelial growth factor expression. Neurosurgery 40:1269–1277

    Article  PubMed  CAS  Google Scholar 

  26. Kalkanis SN, Carroll RS, Zhang J, Zamani AA, Black PM (1996) Correlation of vascular endothelial growth factor messenger RNA expression with peritumoral vasogenic cerebral edema in meningiomas. J Neurosurg 85:1095–1101. doi:10.3171/jns.1996.85.6.1095

    Article  PubMed  CAS  Google Scholar 

  27. Ding YS, Wang HD, Tang K, Hu ZG, Jin W, Yan W (2008) Expression of vascular endothelial growth factor in human meningiomas and peritumoral brain areas. Ann Clin Lab Sci 38:344–351

    PubMed  CAS  Google Scholar 

  28. Friedman HS, Prados MD, Wen PY, Mikkelsen T, Schiff D, Abrey LE, Yung WK, Paleologos N, Nicholas MK, Jensen R, Vredenburgh J, Huang J, Zheng M, Cloughesy T (2009) Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. J Clin Oncol 27:4733–4740

    Article  PubMed  CAS  Google Scholar 

  29. Kreisl TN, Kim L, Moore K, Duic P, Royce C, Stroud I, Garren N, Mackey M, Butman JA, Camphausen K, Park J, Albert PS, Fine HA (2009) Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol 27:740–745

    Article  PubMed  CAS  Google Scholar 

  30. Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972

    Article  PubMed  Google Scholar 

  31. Puchner MJ, Hans VH, Harati A, Lohmann F, Glas M, Herrlinger U (2010) Bevacizumab-induced regression of anaplastic meningioma. Ann Oncol 21:2445–2446. doi:10.1093/annonc/mdq634

    Article  PubMed  CAS  Google Scholar 

  32. DeBoer R, Grimm SA, Chandler J, Gallot L, Kennedy S, Burns K, Rice L, Cabreza C, Muro K, Raizer JJ (2008) A phase II trial of PTK-787 (PTK/ZK) in recurrent or progressive meningiomas. J Clin Oncol [2008 ASCO annual meeting proceedings (post-meeting edition)] 26:2060

  33. Reardon DA, Norden AD, Desjardins A, Vredenburgh JJ, Herndon JE II, Coan A, Sampson JH, Gururangan S, Peters KB, McLendon RE, Norfleet JA, Lipp ES, Drappatz J, Wen PY, Friedman HS (2011) Phase II study of Gleevec((R)) plus hydroxyurea (HU) in adults with progressive or recurrent meningioma. J. J Neurooncol. doi:10.1007/s11060-011-0687-1

    Google Scholar 

  34. Chamberlain MC, Johnston SK (2011) Hydroxyurea for recurrent surgery and radiation refractory meningioma: a retrospective case series. J Neurooncol. doi:10.1007/s11060-011-0541-5

    Google Scholar 

  35. Chamberlain MC, Tsao-Wei DD, Groshen S (2006) Salvage chemotherapy with CPT-11 for recurrent meningioma. J Neurooncol 78:271–276

    Article  PubMed  CAS  Google Scholar 

  36. Hahn BM, Schrell UM, Sauer R, Fahlbusch R, Ganslandt O, Grabenbauer GG (2005) Prolonged oral hydroxyurea and concurrent 3d-conformal radiation in patients with progressive or recurrent meningioma: results of a pilot study. J Neurooncol 74:157–165. doi:10.1007/s11060-004-2337-3

    Article  PubMed  CAS  Google Scholar 

  37. Chamberlain MC, Tsao-Wei DD, Groshen S (2004) Temozolomide for treatment-resistant recurrent meningioma. Neurology 62:1210–1212

    Article  PubMed  CAS  Google Scholar 

  38. Chamberlain MC, Glantz MJ (2008) Interferon-alpha for recurrent World Health Organization grade 1 intracranial meningiomas. Cancer 113:2146–2151

    Article  PubMed  CAS  Google Scholar 

  39. Johnson DR, Kimmel DW, Burch PA, Cascino TL, Giannini C, Wu W, Buckner JC (2011) Phase II study of subcutaneous octreotide in adults with recurrent or progressive meningioma and meningeal hemangiopericytoma. Neuro Oncol 13:530–535. doi:10.1093/neuonc/nor044

    Article  PubMed  CAS  Google Scholar 

  40. Chamberlain MC, Glantz MJ, Fadul CE (2007) Recurrent meningioma: salvage therapy with long-acting somatostatin analogue. Neurology 69:969–973

    Article  PubMed  CAS  Google Scholar 

  41. Goodwin JW, Crowley J, Eyre HJ, Stafford B, Jaeckle KA, Townsend JJ (1993) A phase II evaluation of tamoxifen in unresectable or refractory meningiomas: a Southwest Oncology Group study. J Neurooncol 15:75–77

    Article  PubMed  CAS  Google Scholar 

  42. Grunberg SM, Rankin C, Townsend J et al (2001) Phase III double-blind randomized placebo-controlled study of mifepristone (RU) for the treatment of unreasectable meningioma. Proc Am Soc Clin Oncol 20:222

    Google Scholar 

Download references

Acknowledgments

This work was supported by NIH Grants 5P50-NS-20023 and 5 R37 CA11898; NIH Grant MO1 RR 30, GCRC Program, NCRR; and NCI SPORE 1 P20 CA096890; and a grant from Genentech Pharmaceuticals.

The authors thank Wendy Gentry for her excellent secretarial support in the development of this manuscript.

Author information

Author notes

  1. Emil Lou

    Present address: Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, 55455, USA

Authors and Affiliations

  1. Department of Surgery, The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Durham, NC, 27710, USA

    Emil Lou, Ashley L. Sumrall, Scott Turner, Julie Norfleet, Henry S. Friedman & David A. Reardon

  2. Departments of Medicine, The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Durham, NC, 27710, USA

    Katherine B. Peters, Annick Desjardins & James J. Vredenburgh

  3. Department of Pathology, The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Durham, NC, 27710, USA

    Roger E. McLendon

  4. Cancer Center Biostatistics, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, 27710, USA

    James E. Herndon II & Frances McSherry

  5. Department of Pediatrics, The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Durham, NC, 27710, USA

    Henry S. Friedman & David A. Reardon

  6. Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, SW-460G, Boston, MA, 02215, USA

    David A. Reardon

Authors
  1. Emil Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashley L. Sumrall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katherine B. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Annick Desjardins
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James J. Vredenburgh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roger E. McLendon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. James E. Herndon II
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Frances McSherry
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Julie Norfleet
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Henry S. Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. David A. Reardon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David A. Reardon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lou, E., Sumrall, A.L., Turner, S. et al. Bevacizumab therapy for adults with recurrent/progressive meningioma: a retrospective series. J Neurooncol 109, 63–70 (2012). https://doi.org/10.1007/s11060-012-0861-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-012-0861-0

Keywords

Search

Navigation