Bevacizumab treatment for radiation brain necrosis: mechanism, efficacy and issues

Mol Cancer. 2019 Feb 7;18(1):21. doi: 10.1186/s12943-019-0950-1.

Abstract

Vascular damage is followed by vascular endothelial growth factor (VEGF) expression at high levels, which is an important mechanism forradiation brain necrosis development. Bevacizumab alleviates brain edema symptoms caused by radiation brain necrosis through inhibiting VEGF and acting on vascular tissue around the brain necrosis area. Many studies have confirmed that bevacizumab effectively relieves symptoms caused by brain necrosis, improves patients' Karnofsky performance status (KPS) scores and brain necrosis imaging. However, necrosis is irreversible, and hypoxia and ischemia localized in the brain necrosis area may easily lead to radiation brain necrosis recurrence after bevacizumab is discontinued. Further studies are necessary to investigate brain necrosis diagnoses, bevacizumab indications, and the optimal mode of administration, bevacizumab resistance and necrosis with a residual or recurrent tumor.

Keywords: Bevacizumab; Drug resistance; Indication; Radiation brain necrosis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use*
  • Bevacizumab / therapeutic use*
  • Brain / blood supply
  • Brain / drug effects
  • Brain / pathology
  • Brain / radiation effects
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / genetics
  • Brain Ischemia / pathology
  • Drug Resistance / genetics
  • Gamma Rays / adverse effects
  • Gene Expression
  • Humans
  • Necrosis / drug therapy*
  • Necrosis / genetics
  • Necrosis / pathology
  • Neovascularization, Pathologic / genetics
  • Neovascularization, Pathologic / pathology
  • Neovascularization, Pathologic / prevention & control*
  • Radiation Injuries / drug therapy*
  • Radiation Injuries / genetics
  • Radiation Injuries / pathology
  • Recurrence
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Vascular Endothelial Growth Factor A / genetics
  • Vascular Endothelial Growth Factor A / metabolism

Substances

  • Angiogenesis Inhibitors
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Bevacizumab