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01-09-2019 | Vestibular Schwannoma | Topic Review

Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2: a systematic review and meta-analysis of treatment outcomes

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

Published in: Journal of Neuro-Oncology | Issue 2/2019

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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Title: Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2: a systematic review and meta-analysis of treatment outcomes
Authors: Victor M. Lu
Krishnan Ravindran
Christopher S. Graffeo
Avital Perry
Jamie J. Van Gompel
David J. Daniels
Michael J. Link
Publication date: 01-09-2019
Publisher: Springer US
Keywords: Vestibular Schwannoma
Neurofibromatosis
Vestibular Schwannoma
Neurofibromatosis
Schwannoma
Bevacizumab
Published in: Journal of Neuro-Oncology / Issue 2/2019
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-019-03234-8

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Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2: a systematic review and meta-analysis of treatment outcomes

Abstract

Background

Methods

Results

Conclusions

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Abstract

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