Marked recovery of vision in children with optic pathway gliomas treated with bevacizumab

• Published in: JAMA ophthalmology Vol. 132; no. 1; p. 111
• Main Authors: Avery, Robert A, Hwang, Eugene I, Jakacki, Regina I, Packer, Roger J
• Format: Journal Article
• Language: English
• Published: United States 01.01.2014
• Subjects: Adolescent; Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Bevacizumab; Child; Female; Humans; Injections, Intravenous; Magnetic Resonance Imaging; Optic Chiasm - drug effects; Optic Chiasm - physiopathology; Optic Nerve Glioma - drug therapy; Optic Nerve Glioma - physiopathology; Optic Nerve Neoplasms - drug therapy; Optic Nerve Neoplasms - physiopathology; Recovery of Function - physiology; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Vision, Ocular - physiology; Visual Acuity - drug effects; Visual Field Tests; Visual Fields - drug effects
• ISSN: 2168-6173
• DOI: 10.1001/jamaophthalmol.2013.5819

Children with optic pathway gliomas (OPGs) frequently experience vision loss from their tumors. Standard front-line treatment using carboplatin-based chemotherapy typically produces only a modest benefit (eg, stabilization or 0.2 logMAR improvement) in visual acuity (VA). Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor and acts primarily as an anti-angiogenic agent. Recent reports suggest a qualitative improvement in vision after bevacizumab-based treatment in children with OPGs. We report 4 cases of pediatric OPGs (2 neurofibromatosis type 1-related and 2 sporadic cases) that received treatment with bevacizumab due to progressive VA or visual field (VF) loss despite prior treatment with chemotherapy or proton-beam radiation. All 4 subjects demonstrated a marked improvement in their VA, VF, or both while receiving bevacizumab-based therapy. Three patients had complete resolution of their VA or VF loss in at least 1 eye-2 of whom had previously received bevacizumab therapy. Given that most patients with OPG-related visual impairment will show modest or no visual improvement with standard treatment, the incorporation of bevacizumab in these cases may greatly improve visual outcomes and should be considered in appropriate clinical situations.