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Otolaryngol Head Neck Surg. 2019 Mar;160(3):526-532. doi: 10.1177/0194599818809085. Epub 2018 Oct 30.

Bevacizumab for Hearing Preservation in Neurofibromatosis Type 2: Emphasis on Patient-Reported Outcomes and Toxicities.

Author information

1
1 Department of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, Minnesota, USA.
2
2 Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
3
3 Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
4
4 Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.
5
5 Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota, USA.

Abstract

OBJECTIVE:

Bevacizumab for hearing preservation in patients with neurofibromatosis type 2 (NF2) is an emerging practice. We set out to characterize the effectiveness and toxicity of bevacizumab in our patient group.

STUDY DESIGN:

Case series with chart review.

SETTING:

Tertiary referral center.

SUBJECTS AND METHODS:

Seventeen consecutive patients with NF2 received bevacizumab treatment for vestibular schwannomas, including 2 patients treated to maintain cochlear implant performance. Volumetric analysis of serial magnetic resonance imaging scans was used to evaluate radiographic response, and hearing response was evaluated with serial audiograms. Patient-reported outcomes were also assessed, including subjective hearing improvement, changes in tinnitus, vertigo, headaches, ear pain, and improvement in ability to communicate via telephone.

RESULTS:

A positive radiographic response occurred in 8 of 17 (47%) patients and the median tumor volume change was a tumor decrease of 19%. A positive hearing response was recorded in 5 of 9 (56%) patients. Two patients had a word recognition score improvement over 40%. There was an approximately 40% improvement in patient-reported outcomes. Primary toxicities included hypertension, proteinuria, dysgeusia, and amenorrhea.

CONCLUSION:

Bevacizumab treatment was followed by hearing improvement in 56% of patients, while decreased tumor volume was noted in 47%. These outcomes agree favorably with prior reported series. There were significant improvements in patient-reported outcomes that have not been described previously.

KEYWORDS:

NF2; bevacizumab; neurofibromatosis type 2; patient-reported outcomes; vestibular schwannoma

PMID:
30373466
DOI:
10.1177/0194599818809085

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