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Hearing improvement after bevacizumab in patients with neurofibromatosis type 2
New England Journal of Medicine, 07/27/09

Plotkin SR et al. – Vascular endothelial growth factor (VEGF) blockade with bevacizumab improved hearing in some, but not all, pts with neurofibromatosis type 2 and was associated with reduced volume of most growing vestibular schwannomas.

Methods

Study of the expression pattern of VEGF and 3 of its receptors in samples from 21 vestibular schwannomas associated with neurofibromatosis type 2 and from 22 sporadic schwannomas
VEGF receptors: VEGFR-2, neuropilin-1, and neuropilin-2
Bevacizumab treatment with 10 consecutive pts with neurofibromatosis type 2 and progressive vestibular schwannomas who were not candidates for standard treatment
Imaging response defined as decrease ≥20% in tumor volume vs baseline
Hearing response defined as significant increase in word-recognition score vs baseline

Results

VEGF expressed in 100% of vestibular schwannomas
VEGFR-2 in 32% of tumor vessels
Before treatment, median annual volumetric growth rate for 10 index tumors: 62%
After bevacizumab treatment in 10 pts, tumors shrank in 9, and 6 had imaging response
Imaging response maintained in 4 pts during 11-16 mo of follow-up
Median best response to treatment: volumetric reduction of 26%
Hearing response ineligiblity for 3 pts
Of remaining 7 pts, hearing response for 4, stable hearing for 2, progressive hearing loss for 1
Adverse events of grade 1 or 2: 21

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