Bevacizumab‑associated intracerebral hemorrhage in patients with malignant glioma

Intracerebral hemorrhage (ICH) is a serious complication of the use of bevacizumab in patients with malignant glioma; however, the risk factors are unclear. Therefore, the present study retrospectively analyzed a cohort of patients treated with bevacizumab for malignant glioma to investigate the characteristics of those in the cohort who had ICH. Between January 2015 and December 2022, 64 patients with malignant glioma were treated with bevacizumab. Clinical and molecular biological information, treatment details, and information regarding the presence of ICH after bevacizumab administration were extracted from the hospital database. ICH was found to have occurred in seven patients (10.9%) after bevacizumab administration. The mean (standard deviation) age of these seven patients was 64(11) years, and six of them (85.7%) underwent needle biopsy. Two patients (28.6%) had grade ≥3 hemorrhage. The median number of administrations of bevacizumab before the onset of ICH was seven (range: 1-32), and the duration from first administration to ICH was 4 months (range: 1-22). Furthermore, ICH was associated with a comparatively short overall survival time (log-rank, P=0.008). Tumor invasion into the corpus callosum on contrast-enhanced magnetic resonance imaging before bevacizumab administration was associated with ICH according to univariate analysis (P=0.01) and multivariate analysis (P=0.02). In conclusion, bevacizumab-associated ICH was associated with poor prognosis in the present cohort of patients with malignant glioma. Furthermore, corpus callosum infiltration shown on magnetic resonance imaging before bevacizumab administration was suggested to be a risk factor for ICH; however, further studies on larger cohorts are required for confirmation.