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The risk and burden of thromboembolic and hemorrhagic events in patients with malignant gliomas receiving bevacizumab

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Abstract

Purpose

Bevacizumab has evolved as an integral treatment option for patients with high-grade gliomas. Little is known about clinical risk factors that predispose patients with high-grade gliomas receiving bevacizumab to VTE or ICH. We sought to characterize the clinical risk factors associated with risk of either event.

Methods

In this multi-institutional retrospective study, we first evaluated patients with high-grade gliomas who were treated with bevacizumab at University of Texas MD Anderson Cancer Center from 2015–2021. We compared clinical and treatment-related factors among three cohorts: those who developed VTE, ICH, or neither. We further compared survival outcomes of these patients from the time of bevacizumab initiation. Then to further confirm our results in a non-cancer center hospital setting we evaluated patients from two Ascension Seton Hospitals in Austin, Texas which are affiliated with Dell Medical School at the University of Texas at Austin from 2017–2022.

Results

We found that the presence of cerebral macrobleeding, defined as a magnetic susceptibility of > 1 cm3 on magnetic resonance imaging, was highly associated with risk of developing ICH after initiation of bevacizumab. Development of ICH was significantly associated with poorer survival outcomes. We did not find a statistically significant effect of VTE on survival after bevacizumab initiation.

Conclusion

In order to stratify the risk for developing ICH before the initiation of bevacizumab, we recommend to assess for the presence of cerebral macrobleeding as it is associated with ICH development.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported by the National Institutes of Health/National Cancer Institute under award number P30CA016672 and used the Biostatistics Resource Group. Editorial assistance was provided by Editing Services, Research Medical Library, MD Anderson Cancer Center.

Funding

This work was supported by the National Institutes of Health/National Cancer Institute under award number P30CA016672 and used the Biostatistics Resource Group.

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Author notes

  1. Pushan Dasgupta and Alexander Ou contirbuted equally as first co-authors. Nazanin K. Majd and Justin F Rousseau contributed equally as corresponding authors.

Authors and Affiliations

  1. Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Pushan Dasgupta, Alexander Ou, Timothy Gregory, Carlos Kamiya-Matsuoka & Nazanin K. Majd

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heather Lin & Ying Yuan

  3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kristin D. Alfaro-Munoz

  4. Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vahid Afshar-Khargan

  5. Department of Neurology, UT Southwestern Medical Center, Dallas, TX, 75390, USA

    Justin F. Rousseau

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Contributions

Conception: PD, AO, JR, NM Data acquisition: PD, AO Data analysis: PD, AO HL, YY, VA, JR Data availability and input: KA, CK, TG, NM, JR, PD, AO Wrote the final manuscript: PD Contributed to drafting of manuscript: PD, AO Edited the final manuscript: PD, NM All authors reviewed and approved the manuscript.

Corresponding authors

Correspondence to Justin F. Rousseau or Nazanin K. Majd.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was approved by MD Anderson Cancer Center’s institutional review board.

This study was approved and met criteria for exemption from IRB review by University of Texas at Austin’s Institutional Review Board.

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Prior presentation: SNO 2021 (Society of Neuro-Oncology Annual Conference).

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Dasgupta, P., Ou, A., Lin, H. et al. The risk and burden of thromboembolic and hemorrhagic events in patients with malignant gliomas receiving bevacizumab. J Neurooncol 167, 181–188 (2024). https://doi.org/10.1007/s11060-023-04551-9

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