Bevacizumab treatment in hereditary hemorrhagic teleangiectasia
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- Föllner, S., Ibe, M. & Schreiber, J. Eur J Clin Pharmacol (2012) 68: 1685. doi:10.1007/s00228-012-1308-4
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To the Editor,
Taugourdeau-Raymond and co-workers reported a high frequency of severe bevacizumab-induced adverse effects in the January 2012 issue of this journal . Although only patients with malignant disorders were included, these data are of outstanding importance. Nowadays bevacizumab is increasingly used for off-label treatment, e.g., in macular degeneration and hereditary hemorrhagic teleangiectasia (HHT) (Morbus Osler-Rendu-Weber syndrome). Assessment of the risk-benefit ratio demands awareness of treatment failures in this setting.
There are several reports on positive effects of treating HHT with bevacizumab, an antibody against the vascular endothelial growth factor (VEGF) [2–9]. This is the first report on failure of this therapy. HHT is characterized by arteriovenous malformations that may occur in various organs and lead to epistaxis and gastrointestinal and pulmonary bleeding among other manifestations. There is no curative therapy so far.
These two cases demonstrate that efficacy of bevacizumab-treatment in HHT is not definitive and not predictable. One possible explanation might be that VEGF is expressed differently in different genetic variants of the disease . We presume that a variation in the structure of VEGF in HHT can cause resistance against bevacizumab.