Cerebrovascular Events After Bevacizumab Treatment: An Early and Severe Complication

The indications for bevacizumab (a vascular endothelial growth factor inhibitor) have been expanded recently. Despite concerns for cerebrovascular events from bevacizumab treatment, detailed clinical and radiologic information are lacking. Using the Mayo Clinic Rochester database (January 2006-September 2010), we identified bevacizumab-treated patients who developed intracerebral hemorrhage, ischemic stroke or transient ischemic attack within 3 weeks of bevacizumab treatment. Functional recovery was assessed using the modified Rankin scale 3 months following the onset of cerebrovascular events. Ten consecutive patients (median age 58 years, range 37-86) were included in this study. These patients received bevacizumab for a median duration of 3 months (range 2-4 months) for cancer treatment, and developed cerebrovascular events that comprised intratumoral hemorrhage (n = 7), cerebral watershed infarction (n = 1), transient ischemic attack (n = 1), and left vertebral artery occlusion (n = 1). Seven patients had chronic hypertension which was adequately controlled with a single anti-hypertensive agent. Significant increase in blood pressure was observed in nine patients during their acute presentation as compared with their baseline outpatient readings. Six patients died within 3 months of these cerebrovascular events, and the remaining four patients had modest functional recovery. Cerebrovascular events are early and serious complications that should be considered in bevacizumab-treated patients who present with an acute neurologic deterioration.