Avastin in Meningioma and in Neurofibromatosis – pro

Meningiomas are often vascularized tumors and and it is reasonable to consider antiangiogenic therapy for meningioma. In particular, malignant meningiomas produce high levels of vascular endothelial growth factor (VEGF) and the Avastin blocks this growth factor. Meningiomas in neurofibromatosis often occur together which schwanomas and other similar tumors. Unfortunately, the currently consists only of case reports supporting this approach. The  only Phase II trial includes meningiomas as well as schwannomas and other neurofibromatosis related tumors. The Nyack et al paper is a retrospective review of 15 patients treated with Avastin and does not rise to the level of evidence above. NCCN only recommends Interferon, Somatostatin analogues or Sunitininb (Category 2B).The treatment is therefore investigational.

James H. Tonsgard, MD Clinical Manifestations and Management of Neurofibromatosis Type 1
Semin Pediatr Neurol 13:2-7 © 2006

S. Goutagny et al, Radiographic regression of cranial meningioma in a NF2 patient treated by bevacizumab Ann Oncol (2011) 22(4): 990-991

Plotkin SR. et al, Hearing improvement after bevacizumab in patients with neurofibromatosis type 2. N Engl J Med 2009;61:58-67.

Bevacizumab induces regression of vestibular schwannomas in patients with neurofibromatosis type 2. Neuro Oncol 2010;12:14-18.

Panagopoulos AT et al,  Radiographic regression of vestibular schwannomas induced by bevacizumab treatment: sustain under continuous drug application and rebound after drug discontinuation. Ann Oncol 2010;21:2294-2295.

Nayak L, Iwamoto FM, Rudnick JD, Norden AD, Lee EQ, Drappatz J, Omuro A, Kaley TJ. Atypical and anaplastic meningiomas treated with bevacizumab. J Neurooncol. 2012 Aug;109(1):187-93. 

NCCN Meningioma, MENI-1 2016

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