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  • Intra-arterial and Intra-venous Delivery of Bevacizumab Have Synergistic Effects in Recurrent Glioblastoma Treatment: Impact on Symptom Control, Steroid Dose and MRI Tumor Volume

    Final Number:

    Matei A Banu MD; Michael Mooney; Kartik Kesavabhotla; Casey Tsai; Nicholas Berry; John A. Boockvar MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Current salvage therapy for recurring high grade gliomas, glioblastoma multiforme (GBM) and anaplastic astrocytoma has little impact on the dismal prognosis after failure of first line therapy. Insufficient delivery across the blood brain barrier (BBB) by intravenous administration seemingly is one of the impeding factors in employing an effective treatment regimen. Bevacizumab (BV), a VEGF monoclonal antibody, leads to symptom improvement primarily by reducing peritumoral edema around these highly vascular tumors.

    Methods: Seventeen patients demonstrating treatment failures, increase of over 25% under standard chemotherapy, were assigned in nonrandomized fashion to one of three treatment arms: A. 12 patients, intra-arterial (IA) Bevacizumab single dose (15mg/kg) followed by biweekly intra-venous (IV) bevacizumab (10mg/kg) B. 2 patients, IA Bevacizumab, single dose (15mg/kg) C. 3 patients, repeat IA bevacizumab (15mg/kg). BBB disruption with Mannitol was used in each super-selective intra-arterial BV infusion.

    Results: Clinical response and symptom improvement were observed in four group A patients (33.3%). One patient described vision improvement in group C. The mean Karnofsky performance score after treatment was 77±11, with the best score seen in arm C, 80±0. A decrease in dexamethasone dose was possible in two IA+IV patients and in one single dose IA patient, only three patients in arm A requiring increasing steroid levels for symptom control. According to the RANO MRI criteria, ten patients (83.3%) in group A showed a decrease in tumor volume while all patients with single IA BV demonstrated stable disease. However, progression of disease was noted at two months in two out of three group C patients (66.6%). In terms of toxicity, pulmonary vessel thrombosis, truncal rash and transient groin hematoma were identified in three patients of arm A.

    Conclusions: Intra-arterial combined with intra-venous delivery of bevacizumab is an effective treatment method for recurrent GBM leading to symptom alleviation, stable steroid dosage and imagistic tumor response.

    Patient Care: The current study looks at alternative methods of delivery of avastin in recurrent GBM to improve patient survival.

    Learning Objectives: At the end of this presentations participants should be able to identify the benefits and risks of IA vs IV avastin delivery,to properly employ RANO criteria in assessing response to BV treatment, accurately describe the methodology of IA chemotherapy delivery for super-selective infusion.


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