Cancer Treatment Today

There are only a few published case reports on the use of Avastin in the treatment of HHT, as can be expected for a rare condition. The first report was published in 2006 by Flieger. Treatment with bevacizumab stabilized the patient’s concurrent cancer and also markedly improved his anemia and reduced his need for blood transfusion.  In 2008, Mitchell and colleagues reported a HHT patient who had improvement in heart failure due to liver AVM after treatment with bevacizumab. The  largest series was form the HHT Center in San Diego by Dr. Simonds and Davidson; 10 patients with HHT related nosebleeds received injection of low dose bevacizumab inside the nose along with laser treatment.  When compared to other patients from the past who had received only laser treatments by the same surgeon (Dr. Terry Davidson), the patients who received bevacizumab + laser showed a modest improvement in frequency of nosebleeds, need for blood transfusions, and quality of life.    There are other scattered reports and anecdotal observations. When only case reports exist, a reporting bias(unsuccessful treatments tend not to be reported) becomes a barrier to interpreting the literature.

Mitchell A, Adams LA, MacQuillan G, Tibballs J, vanden Driesen R, Delriviere L.Bevacizumab reverses need for liver transplantation in hereditary hemorrhagic telangiectasia. Liver Transpl. 2008 Feb;14(2):210-3.

Flieger D, Hainke S, Fischbach W.Dramatic improvement in hereditary hemorrhagic telangiectasia after treatment with the vascular endothelial growth factor (VEGF) antagonist bevacizumab. Ann Hematol. 2006 Sep;85(9):631-2.

Davidson TM, Olitsky SE, Wei JL.Hereditary hemorrhagic telangiectasia/avastin. Laryngoscope. 2010 Feb;120(2):432-5.