Anti-angiogenic therapy in high-grade glioma (treatment and toxicity)

Malignant gliomas continue to have a very poor prognosis and treatment responses at recurrence are very limited. Though anti-angiogenic therapy has not yet been shown to extend overall survival in this patient population, there is likely substantial benefit to reducing vasogenic edema, allowing for temporary improvement in neurologic function, and minimizing the side effects of prolonged corticosteroid use. A trial of bevacizumab should be considered in those with worsening vasogenic cerebral edema such as seen in recurrent malignant gliomas, radiation necrosis, or progressive brain metastases. However, not all patients respond to anti-angiogenic treatment and if no radiographic or clinical responses are seen, then patients are not likely to benefit from further infusions. Though it is commonly well tolerated, some side effects, while rare, may be life threatening, and should be discussed with patients and their families. These discussions should also outline the goals of initiating therapy and when treatment should be stopped.