Neurosurgical issues related to bevacizumab use in the management of glioblastoma

© 2013 Wolters Kluwer Health, Inc. Bevacizumab (BV) is a monoclonal antibody to vascular endothelial growth factor (VEGF), which has demonstrated great promise in the management of recurrent glioblastoma (GBM) and other solid metastatic tumors. It improves progression free survival, decreases tumor vascularization, contrast enhancement on magnetic resonance imaging, and symptoms of cytotoxic cerebral edema. The potential benefit of BV has led to a more widespread use in patients with GBM recurrence. However, given the possibility that BV may also be indicated as first-line therapy, neurosurgeons are likely to encounter a substantially larger number of patients being considered for repeat craniotomy and resection who have recently been exposed to this drug. This agent is associated with a number of side effects such as hypertension, hemorrhage, thrombosis, wound healing complications, thrombocytopenia, etc. Hence, it is imperative for neurosurgeons to be aware of issues surrounding this drug as it may affect surgical outcomes and can lead to postoperative complications. In this review, we will discuss several salient points specific to BV use in GBM, mechanisms of action, side effects, and presurgical considerations surrounding this novel agent.