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Changes in protein level in the cerebrospinal fluid of a patient with cerebral radiation necrosis treated with bevacizumab.

Yano H, Nakayama N, Morimitsu K, Futamura M, Ohe N, Miwa K, Shinoda J, Iwama T - Clin Med Insights Oncol (2014)

Bottom Line: Interestingly, after 2 days, the agents had dramatically reduced the CSF protein level.After 10 courses of this regimen, the CSF protein level decreased to 338 mg/dL, which is less than half of the initial level.Long-term administration of bevacizumab might decrease leakage of protein from the vessels around the ventriculus.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.

ABSTRACT
A 32-year-old woman underwent surgeries and radiation therapy for astrocytoma. She developed symptomatic radiation necrosis in the lesion, which caused hydrocephalus. She initially underwent ventricular drainage, because the protein level in the cerebrospinal fluid (CSF) was 787 mg/dL, which was too high for shunt surgery. Because she also had breast cancer, which was pathologically diagnosed as an invasive ductal carcinoma, standard bevacizumab therapy in combination with paclitaxel every 2 weeks was selected. Interestingly, after 2 days, the agents had dramatically reduced the CSF protein level. However, it returned to approximately the initial level within 2 weeks. After two courses of this regimen, a ventriculoperitoneal shunt was placed. After 10 courses of this regimen, the CSF protein level decreased to 338 mg/dL, which is less than half of the initial level. Long-term administration of bevacizumab might decrease leakage of protein from the vessels around the ventriculus.

No MeSH data available.


Related in: MedlinePlus

Changes in the cerebrospinal fluid protein level during bevacizumab therapy. The graph shows the changes in protein level in the cerebrospinal fluid during chemotherapy. Arrows show the timing of administration of the agents (bevacizumab and paclitaxel). In the second course, only bevacizumab was administered. Arrowhead shows the day of ventriculoperitoneal shunt. The figures on the arrows show the day, of which Day 1 shows the first day of administration. Bidirectional arrow indicates the period of ventricular drainage. The magnetic resonance imaging scans show the axial fluid attenuated inversion recovery images at days 0, 20, 37, and 183.
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f3-cmo-8-2014-153: Changes in the cerebrospinal fluid protein level during bevacizumab therapy. The graph shows the changes in protein level in the cerebrospinal fluid during chemotherapy. Arrows show the timing of administration of the agents (bevacizumab and paclitaxel). In the second course, only bevacizumab was administered. Arrowhead shows the day of ventriculoperitoneal shunt. The figures on the arrows show the day, of which Day 1 shows the first day of administration. Bidirectional arrow indicates the period of ventricular drainage. The magnetic resonance imaging scans show the axial fluid attenuated inversion recovery images at days 0, 20, 37, and 183.

Mentions: Up to this point, the patient had led an independent life in her own home for several years. At 40 years of age, she detected a lump in her right breast. A biopsy of the tumor was performed and an invasive ductal carcinoma was confirmed. Because the tumor was aggressive and refractory to endocrine therapy, she was advised to undergo chemotherapy immediately. However, her activities had become slow, and she presented with urinary incontinence. A CT scan showed ventricular dilatation that indicated normal pressure hydrocephalus caused by the RN. Her symptoms gradually subsided after drainage of the CSF; however, the CSF protein level was 787 mg/dL, which is approximately 20 times higher than the normal level. Accordingly, we hesitated to insert a ventriculoperitoneal (V-P) shunt immediately after the drainage because we were concerned that she was at high risk for obstruction of the shunt. We then utilized an Ommaya reservoir for ventricular drainage before placing the V-P shunt. We observed her neurological conditions during the external ventricular drainage by using an Acti-valve system (medium pressure) (Kaneka Medix Corporation, Osaka, Japan). Despite systemic hydration, a high CSF protein level persisted. We selected bevacizumab to treat the breast cancer (BC) and the RN. Furthermore, we anticipated that the therapy would reduce the CSF protein level by means of reconstructing the vessels that had sustained endothelial damage from the radiation therapy. According to the standard therapy for BC, we intended to administer bevacizumab at a dose of 10 mg/kg of the body weight for 2 weeks in combination with paclitaxel (93 mg/kg of the body weight); however, after the first round of treatment, we could not continue this course because of the general fatigue (grade 2) and the leukopenia (grade 2) as an adverse effect. Consequently, she received only bevacizumab during the second course. Before and after administration of bevacizumab, we measured the changes in the protein level in the CSF obtained from the drainage system (Fig. 3). During the first course, the protein level decreased from the initial level of 787 mg/dL to 582 mg/dL 2 days after administration. However, the level increased to 677 mg/dL on day 10, and the second course (only bevacizumab) was initiated on day 15. The protein level again decreased to 557 mg/dL on day 17; however, it then increased to 723 mg/dL on day 26. Therefore, we observed that the agents dramatically reduced the CSF protein level by >150 mg/dL after 1–2 days of bevacizumab administration. However, the value returned to its initial level within 2 weeks after the first dose. The patient was able to walk smoothly and speak clearly during ventricular drainage that was never occluded, despite the high CSF protein level. Two weeks after the second administration of bevacizumab, we performed a procedure to place a V-P shunt and removed the ventricular drainage system on day 29. At this point, she was barely capable of living independently. Because bevacizumab-related adverse effects had improved, she continued to receive therapy using bevacizumab (10 mg/kg) and paclitaxel (75 mg/kg body weight) for BC after the placement of the V-P shunt. At day 210 (after 10 courses of treatment), the CSF protein level was 338 mg/dL (Fig. 3). She showed no critical adverse effects (more than grade 3) related to bevacizumab therapy after the second course.


Changes in protein level in the cerebrospinal fluid of a patient with cerebral radiation necrosis treated with bevacizumab.

Yano H, Nakayama N, Morimitsu K, Futamura M, Ohe N, Miwa K, Shinoda J, Iwama T - Clin Med Insights Oncol (2014)

Changes in the cerebrospinal fluid protein level during bevacizumab therapy. The graph shows the changes in protein level in the cerebrospinal fluid during chemotherapy. Arrows show the timing of administration of the agents (bevacizumab and paclitaxel). In the second course, only bevacizumab was administered. Arrowhead shows the day of ventriculoperitoneal shunt. The figures on the arrows show the day, of which Day 1 shows the first day of administration. Bidirectional arrow indicates the period of ventricular drainage. The magnetic resonance imaging scans show the axial fluid attenuated inversion recovery images at days 0, 20, 37, and 183.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4263439&req=5

f3-cmo-8-2014-153: Changes in the cerebrospinal fluid protein level during bevacizumab therapy. The graph shows the changes in protein level in the cerebrospinal fluid during chemotherapy. Arrows show the timing of administration of the agents (bevacizumab and paclitaxel). In the second course, only bevacizumab was administered. Arrowhead shows the day of ventriculoperitoneal shunt. The figures on the arrows show the day, of which Day 1 shows the first day of administration. Bidirectional arrow indicates the period of ventricular drainage. The magnetic resonance imaging scans show the axial fluid attenuated inversion recovery images at days 0, 20, 37, and 183.
Mentions: Up to this point, the patient had led an independent life in her own home for several years. At 40 years of age, she detected a lump in her right breast. A biopsy of the tumor was performed and an invasive ductal carcinoma was confirmed. Because the tumor was aggressive and refractory to endocrine therapy, she was advised to undergo chemotherapy immediately. However, her activities had become slow, and she presented with urinary incontinence. A CT scan showed ventricular dilatation that indicated normal pressure hydrocephalus caused by the RN. Her symptoms gradually subsided after drainage of the CSF; however, the CSF protein level was 787 mg/dL, which is approximately 20 times higher than the normal level. Accordingly, we hesitated to insert a ventriculoperitoneal (V-P) shunt immediately after the drainage because we were concerned that she was at high risk for obstruction of the shunt. We then utilized an Ommaya reservoir for ventricular drainage before placing the V-P shunt. We observed her neurological conditions during the external ventricular drainage by using an Acti-valve system (medium pressure) (Kaneka Medix Corporation, Osaka, Japan). Despite systemic hydration, a high CSF protein level persisted. We selected bevacizumab to treat the breast cancer (BC) and the RN. Furthermore, we anticipated that the therapy would reduce the CSF protein level by means of reconstructing the vessels that had sustained endothelial damage from the radiation therapy. According to the standard therapy for BC, we intended to administer bevacizumab at a dose of 10 mg/kg of the body weight for 2 weeks in combination with paclitaxel (93 mg/kg of the body weight); however, after the first round of treatment, we could not continue this course because of the general fatigue (grade 2) and the leukopenia (grade 2) as an adverse effect. Consequently, she received only bevacizumab during the second course. Before and after administration of bevacizumab, we measured the changes in the protein level in the CSF obtained from the drainage system (Fig. 3). During the first course, the protein level decreased from the initial level of 787 mg/dL to 582 mg/dL 2 days after administration. However, the level increased to 677 mg/dL on day 10, and the second course (only bevacizumab) was initiated on day 15. The protein level again decreased to 557 mg/dL on day 17; however, it then increased to 723 mg/dL on day 26. Therefore, we observed that the agents dramatically reduced the CSF protein level by >150 mg/dL after 1–2 days of bevacizumab administration. However, the value returned to its initial level within 2 weeks after the first dose. The patient was able to walk smoothly and speak clearly during ventricular drainage that was never occluded, despite the high CSF protein level. Two weeks after the second administration of bevacizumab, we performed a procedure to place a V-P shunt and removed the ventricular drainage system on day 29. At this point, she was barely capable of living independently. Because bevacizumab-related adverse effects had improved, she continued to receive therapy using bevacizumab (10 mg/kg) and paclitaxel (75 mg/kg body weight) for BC after the placement of the V-P shunt. At day 210 (after 10 courses of treatment), the CSF protein level was 338 mg/dL (Fig. 3). She showed no critical adverse effects (more than grade 3) related to bevacizumab therapy after the second course.

Bottom Line: Interestingly, after 2 days, the agents had dramatically reduced the CSF protein level.After 10 courses of this regimen, the CSF protein level decreased to 338 mg/dL, which is less than half of the initial level.Long-term administration of bevacizumab might decrease leakage of protein from the vessels around the ventriculus.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.

ABSTRACT
A 32-year-old woman underwent surgeries and radiation therapy for astrocytoma. She developed symptomatic radiation necrosis in the lesion, which caused hydrocephalus. She initially underwent ventricular drainage, because the protein level in the cerebrospinal fluid (CSF) was 787 mg/dL, which was too high for shunt surgery. Because she also had breast cancer, which was pathologically diagnosed as an invasive ductal carcinoma, standard bevacizumab therapy in combination with paclitaxel every 2 weeks was selected. Interestingly, after 2 days, the agents had dramatically reduced the CSF protein level. However, it returned to approximately the initial level within 2 weeks. After two courses of this regimen, a ventriculoperitoneal shunt was placed. After 10 courses of this regimen, the CSF protein level decreased to 338 mg/dL, which is less than half of the initial level. Long-term administration of bevacizumab might decrease leakage of protein from the vessels around the ventriculus.

No MeSH data available.


Related in: MedlinePlus