The controversial role of Bevacizumab in the treatment of patients with intracranial meningioma: a comprehensive literature review

ABSTRACT

Introduction: Meningiomas represent the most common primary intracranial tumors. Today, surgical resection, followed by radiotherapy when indicated, is still the treatment of choice. In recent years, distinct oncogenic pathways have been identified, laying the foundations of new personalized targeted therapies.

Areas covered: The aim of this study was to highlight the effects, complications, possible associations with other therapeutic approaches and multi-parametric outcome evaluation of Bevacizumab for the treatment of meningiomas. A literature review according to PRISMA criteria regarding the role of Bevacizumab for the treatment of various WHO grades of meningiomas was performed. 15 relevant papers, including 6 retrospective clinical trial series, 3 prospective trials, and 6 single patient case reports for a total of 134 patients and 211 meningiomas were include.

Expert opinion: Because of the lack of strong clinical evidence about improved survival and related toxicity, the use of Bevacizumab for the treatment of meningiomas should be carefully evaluated. Further exploration, ideally with randomized controlled trials, is needed to better define the role of this drug in the treatment of meningiomas.

KEYWORDS:

• Bevacizumab
• immunotherapy
• meningioma
• personalized therapy
• targeted inhibitors

Article highlights

• WHO grade II and III meningiomas and meningioma multiple recurrences require additional lines of treatment.

• There is a lack of evidence about the role of chemotherapy alone or as an adjuvant treatment after surgery and radiotherapy.

• Several studies have suggested a critical role for vascular endothelial growth factor (VEGF) in meningioma pathogenesis.

• Bevacizumab, a monoclonal antibody specifically directed against vascular endothelial growth factor (VEGF), has been tested for the treatment of recurrent high-grade malignant meningiomas.

• We found a lack of strong evidence about the improved survival of patients suffering from high-grade malignant meningiomas treated with Bevacizumab.

• Data about toxicity are limited or their description is imprecise.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper received no funding.