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Bevacizumab and Glioblastoma Multiforme

A Thrombosis and Bleeding Dilemma (A Case Report and a Brief Review of the Literature)

Patel, Deepa DO; Salkeni, Mohamad MD; Chaudhary, Rekha MD

doi: 10.1097/MJT.0b013e31824ea634
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Glioblastoma multiforme (GBM) is the most aggressive malignant primary brain tumor in adults. It is a highly vascularized tumor, and the advent of angiogenic inhibitors, in particular bevacizumab, is thought to be promising for the treatment of these tumors. However, bevacizumab has been associated with an increased risk of arterial and venous thromboembolism and hemorrhage. We report a case of superior vena cava syndrome developing in a glioblastoma patient treated with bevacizumab. Superior vena cava thrombosis in the setting of treatment with vascular endothelial growth factor has not been well-described. The issue arises as how to best manage the hemostatic complications of antiangiogenic agents in patients who have an established risk of bleeding and thrombosis with their GBM. This report discusses the individual risk of bleeding and thrombosis associated with GBM and the use of bevacizumab. Studies suggest that GBM patients who require therapeutic anticoagulation for venous thromboembolic complications while on bevacizumab therapy can be anticoagulated with the risk of bleeding being comparable to that expected from therapeutic anticoagulation alone. However, the potential risks and benefits should be thoroughly discussed with each patient before starting anticoagulation therapy for thrombotic complications.

Oncology Department, University of Cincinnati College of Medicine/University Cincinnati Medical Center, Cincinnati, OH.

Address for correspondence: 3031 Eden Avenue, Apt 358, Cincinnati, OH 45219. E-mail: dpapatel@gmail.com

The authors have no conflicts of interest to declare.

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