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Effect of Combined Bevacizumab and Temozolomide Treatment on Intramedullary Spinal Cord Tumor

Gwak, So-Jung PhD*; An, Sung Su MS*; Yang, Moon Sul MS*; Joe, Eunhae MS; Kim, Dong-Hyun PhD; Yoon, Do Heum MD, PhD*; Kim, Keung Nyun MD, PhD*; Ha, Yoon MD, PhD*

doi: 10.1097/BRS.0000000000000070
Basic Science

Study Design. C6 glioma cells and an intramedullary spinal cord tumor model were used to evaluate the effect of bevacizumab (Avastin) or temozolomide (TMZ).

Objective. In this study, we hypothesized that treatment with bevacizumab accelerates the therapeutic effect of TMZ on intramedullary gliomas in an animal model.

Summary of Background Data. Recently therapies for the management of intramedullary malignant gliomas include surgery, chemotherapy, and radiotherapy. Concurrent or adjuvant TMZ has been considered an emerging new treatment for intramedullary malignant gliomas; however, high-dose application of TMZ has limitation of side effect.

Methods. C6 glioma cells were injected into the T5 level of the spinal cord, and TMZ and bevacizumab were administered 5 days after C6 inoculation (n = 7 for each group). Tumor size was analyzed using histology and magnetic resonance imaging at 13 days after tumor inoculation.

Results. Histological analyses and magnetic resonance imaging findings showed that combined treatment with TMZ and bevacizumab reduced tumor mass. The tumor volume of control group was 2.8-fold higher than combined therapy (P < 0.05). Neurological outcomes demonstrated that combined therapy improved hind limb function more than TMZ-alone group or control group (P < 0.05).

Conclusion. This study shows that bevacizumab could be useful in combination with TMZ to increase the therapeutic benefits of TMZ for intramedullary spinal cord tumors.

Level of Evidence: N/A

Temozolomide (TMZ) has been considered an emerging new treatment for indicating intramedullary spinal cord tumors. We hypothesized that treatment with bevacizumab accelerates the therapeutic effect of TMZ on intramedullary gliomas. The combined treatment with TMZ and bevacizumab reduced tumor mass and improved hind limb function more than TMZ-alone group or control group.

*Spine & Spinal Cord Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea; and

Department of Electrical and Electronic Engineering, Yonsei University, Shinchondong, Seodaemungu, Seoul, Republic of Korea.

Address correspondence and reprint requests to Yoon Ha, MD, PhD, Department of Neurosurgery, Yonsei University College of Medicine, 120–752, 134 Shinchon-dong, Seodaemoon-gu, Seoul, Korea; E-mail: hayoon@yuhs.ac

Acknowledgment date: March 13, 2013. First revision date: August 1, 2013. Second revision date: September 27, 2013. Acceptance date: October 1, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

The Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012R1A6A3A01017217) and Basic Science Research Program through The National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2011-0011066) grant funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins