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Published at www.nejm.org July 8, 2009 (10.1056/NEJMoa0902579)

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ABSTRACT

Background Profound hearing loss is a serious complication of neurofibromatosis type 2, a genetic condition associated with bilateral vestibular schwannomas, benign tumors that arise from the eighth cranial nerve. There is no medical treatment for such tumors.

Methods We determined the expression pattern of vascular endothelial growth factor (VEGF) and three of its receptors, VEGFR-2, neuropilin-1, and neuropilin-2, in paraffin-embedded samples from 21 vestibular schwannomas associated with neurofibromatosis type 2 and from 22 sporadic schwannomas. Ten consecutive patients with neurofibromatosis type 2 and progressive vestibular schwannomas who were not candidates for standard treatment were treated with bevacizumab, an anti-VEGF monoclonal antibody. An imaging response was defined as a decrease of at least 20% in tumor volume, as compared with baseline. A hearing response was defined as a significant increase in the word-recognition score, as compared with baseline.

Results VEGF was expressed in 100% of vestibular schwannomas and VEGFR-2 in 32% of tumor vessels on immunohistochemical analysis. Before treatment, the median annual volumetric growth rate for 10 index tumors was 62%. After bevacizumab treatment in the 10 patients, tumors shrank in 9 patients, and 6 patients had an imaging response, which was maintained in 4 patients during 11 to 16 months of follow-up. The median best response to treatment was a volumetric reduction of 26%. Three patients were not eligible for a hearing response; of the remaining seven patients, four had a hearing response, two had stable hearing, and one had progressive hearing loss. There were 21 adverse events of grade 1 or 2.

Conclusions VEGF blockade with bevacizumab improved hearing in some, but not all, patients with neurofibromatosis type 2 and was associated with a reduction in the volume of most growing vestibular schwannomas.

Source Information

From the Departments of Neurology (S.R.P.), Pathology (A.O.S.-R.), and Radiation Oncology (T.P.P., A.T., R.K.J., E.T.); the Cancer Center (S.R.P.); the Neurosurgical Service (F.G.B.); and the A.A. Martinos Center for Biomedical Imaging (A.G.S.) — all at Massachusetts General Hospital; and the Department of Audiology, Massachusetts Eye and Ear Infirmary (C.H.) — all in Boston.

This article (10.1056/NEJMoa0902579) was published on July 8, 2009, at NEJM.org.

Address reprint requests to Dr. Plotkin at Yawkey 9E, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, or at splotkin{at}partners.org.

Full Text of this Article

This article has been cited by other articles:

• Guntinas-Lichius, O., Diao, J.-S., Xia, W.-S., Guo, S.-Z., Plotkin, S. R., Halpin, C., Tomaso, E. d. (2009). Hearing Improvement after Bevacizumab for Neurofibromatosis Type 2. NEJM 361: 1809-1811 [Full Text]  
• (2009). Bevacizumab for Vestibular Schwannomas in Neurofibromatosis 2. JWatch Neurology 2009: 5-5 [Full Text]