Ischemic stroke and intracranial hemorrhage in patients with recurrent glioblastoma multiforme, treated with bevacizumab

J Neurooncol. 2017 Jul;133(3):571-579. doi: 10.1007/s11060-017-2467-z. Epub 2017 May 29.

Abstract

Bevacizumab (BVZ), a monoclonal antibody directed against vascular endothelial growth factor (VEGF), has been suspected to increase the incidence of ischemic stroke (IS) and intracranial hemorrhage (ICH) in GBM patients. Intracranial vascular events, such as IS and ICH, were retrospectively analyzed in 364 MRI scans of 82 patients with recurrent GBM (1st/2nd/3rd relapse). Out of these 82 patients, 40 were treated with BVZ (178 scans) in addition to basic treatment, whereas 42 patients matching for age and gender received basic treatment (186 scans). Distribution of typical vascular risk factors between both groups was analyzed retrospectively. In seven out of 82 patients (8%) vascular events were detected in MRI. Four vascular events were recorded in the BVZ-group (3 IS and 1 ICH), and 3 vascular events were found in the Control-group (1 IS and 2 ICH; p > 0.05 between both groups). Likewise, vascular risk factors (arterial hypertension, diabetes mellitus, obesity, former vascular event, hyperlipidemia, tobacco consumption and/or hypercholesterolemia) did not differ significantly between both groups. BVZ treatment does not seem to be associated with an increased risk for vascular events in patients with GBM in recurrence.

Keywords: Antiangiogenic agents; Bevacizumab; Hemorrhage; Ischemic stroke; Recurrent glioblastoma.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents, Immunological / adverse effects
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Bevacizumab / adverse effects
  • Bevacizumab / therapeutic use*
  • Brain / diagnostic imaging
  • Brain / drug effects
  • Brain Ischemia / complications*
  • Brain Ischemia / diagnostic imaging
  • Brain Neoplasms / complications
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / drug therapy
  • Female
  • Follow-Up Studies
  • Glioblastoma / complications
  • Glioblastoma / diagnostic imaging
  • Glioblastoma / drug therapy*
  • Humans
  • Intracranial Hemorrhages / complications*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / complications
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / drug therapy
  • Retrospective Studies
  • Risk Factors
  • Stroke / complications*
  • Stroke / diagnostic imaging
  • Survival Analysis

Substances

  • Antineoplastic Agents, Immunological
  • Bevacizumab