Case Report
Pitfalls with Bevacizumab and Brain Metastasis
Habib Nourani Khojasteh*
Department of Internal Medicine, Nemazi Hospital, Shiraz University of Medical Sciences, Shiraz-Iran
*Corresponding author: Habib Nourani Khojasteh, Department of Internal Medicine, Hematology Research Center, Nemazi Hospital, Shiraz University of Medical Sciences, Shiraz-Iran
Published: 19 Apr, 2017
Cite this article as: Khojasteh HN. Pitfalls with
Bevacizumab and Brain Metastasis.
Ann Clin Case Rep. 2017; 2: 1340.
Editorial
Brain metastasis is a common medical entity; and occurs in near 40% of advanced cancer
patients. Controlling of brain metastasis is important from the aspects of neurological morbidity
and increasing overall survival; resistant mechanisms seen in biology of metastasis and problems of
blood brain barrier (BBB) is the major obstacles in handling of this disease with a poor prognosis
clinical course; blood brain barrier limits the passage of large molecules and hydrophobic drugs to
brain but the metastatic brain lesions specifically disrupt BBB and helps to availability of antitumor
drugs in the sites of the target lesions.
Recently Bevacizumab, a humanized monoclonal antibody that inhibits vascular endothelial
growth factor and controls tumor angiogenesis is a new therapeutic option in central nervous
system metastatic tumor disease. Historically it is used in cancers of lung, brain, ovary, colorectal
and renal tumors; in one study Bevacizumab has the potential to prevent brain metastasis in lung
adenocarcinoma. It can pass BBB despite high molecular weight so the Bevacizumab is still an
interesting in cancer practice because of efficient antitumor effects in brain. It has been approved
by federal drug administration for glioblastoma with high response rate and less risk of brain
hemorrhage because of this Bevacizumab and glioblastoma of brain is the best model of the normal
brain and abnormal brain reaction to this antiangiogenesis drug [1,2].
With successful Using of Bevacizumab in treatment of primary brain tumors, the data showed
safety of this drug in using metastatic brain disease regarding brain hemorrhage. Combination
therapy with bevacizumab and irinote can have response rate and extend survival rate in a group of
metastatic brain with colorectal cancers and leads to no any brain hemorrhage [3,4].
But how much is the risk of brain hemorrhage with bevacizumab and brain metastasis? It needs
to be cautious in every patients with active brain metastasis; Bevacizumab may rarely cause blood
clots (such as pulmonary embolism, stroke, heart attack, deep vein thrombosis the risk is high with
other thrombogenic conditions and also with concomitant risk of bleeding.
Is it necessary to do brain image before bevacizumab in metastatic settings? It seems that if the
patient with cancer is on anticoagulation such as heparin and warfarin and it is a therapeutic plan
to use bevacizumab, this is mandatory to do a brain image before starting bevacizumab because of
risk of tumor hemorrhage is high. Overall the research on the brain metastasis and bevacizumab is
a growing field of cancer science and it needs many more clinical trials in future to open the truth
of this molecule in brain [5,6].
References
- Joan Seoane, Leticia de mattus aruda. Brain metastasis: new opportunities to tackle therapeutic resistance. Mol Oncol. 2014;8(6):1120-1.
- De Braganca KC, Janjigian YY, Azzoli CG, Kris MG, Pietanza MC, Nolan CP, et al. Efficacy and safety of bevacizumab in active brain metastases from non-small cell lung cancer. J Neurooncol. 2010;100(3):443-7.
- Zustovich F, Ferro A, Lombardi G, Farina P, Zagonel V. Bevacizumab based therapy for patients with brain metastases from nonesmall cell lung cancer preliminary results. Chemotherapy. 2014;60(5-6):294-299.
- Evelyn M, Brosnan Kamilo, E Fadul. Outcome of combined bevacizumab and irinotecan for patients with brain metastasis from nonesmall cell lung cancer. J Clin Oncol. 33:2015.
- Nishimura T, Furihata M, Kubo H, Tani M, Agawa S, Setoyama R, et al. Intracranial hemorrhage in patients treated with bevacizumab: report of two cases. World J Gastroenterol. 2011;17(39):4440-4.
- Khasraw M, Holodny A, Goldlust SA, DeAngelis LM. Intracranial hemorrhage in patients with cancer treated with bevacizumab: the Memorial Sloan-Kettering experience. Ann Oncol. 2012;23(2):458-63.