Top Line: What is your go-to treatment for cerebral radionecrosis to avoid long term steroid use?
The Study: Vascular endothelial growth factor (VEGF) appears to play a key role in cerebral radionecrosis by facilitating the development of aberrant blood vessels that come with capillary leakage producing the oft-cited radiographic vasogenic edema. Enter the anti-VEGF monoclonal antibody bevacizumab as a commonsense treatment strategy to curb the vascular permeability problem with at least one randomized trial confirming an improvement in neurologic symptoms. The practical question then becomes whether the clinic benefit is worth the enormous price tag. This economic analysis modeled a two-month course of IV bev 5mg/kg q2 weeks x 4 versus a two-month slow taper of prednisone for the management of cerebral radionecrosis following definitive radiation for nasopharyngeal cancer. On average, bev added 0.11 quality-adjusted life years (QALY) at the cost of $12,351, which comes out to $112,987/QALY. Ultimately, a practical strategy may be reserving a 2-month course of IV bev for patients with symptoms refractory to initial steroid management.
TBL: “Based on our base-case analysis of cost-effectiveness, short-term use of bevacizumab would be more favored than that of corticosteroids in the US at the willingness to pay threshold of $150,000/QALY.” | Lai, Pract Radiat Oncol 2024
The Study: Vascular endothelial growth factor (VEGF) appears to play a key role in cerebral radionecrosis by facilitating the development of aberrant blood vessels that come with capillary leakage producing the oft-cited radiographic vasogenic edema. Enter the anti-VEGF monoclonal antibody bevacizumab as a commonsense treatment strategy to curb the vascular permeability problem with at least one randomized trial confirming an improvement in neurologic symptoms. The practical question then becomes whether the clinic benefit is worth the enormous price tag. This economic analysis modeled a two-month course of IV bev 5mg/kg q2 weeks x 4 versus a two-month slow taper of prednisone for the management of cerebral radionecrosis following definitive radiation for nasopharyngeal cancer. On average, bev added 0.11 quality-adjusted life years (QALY) at the cost of $12,351, which comes out to $112,987/QALY. Ultimately, a practical strategy may be reserving a 2-month course of IV bev for patients with symptoms refractory to initial steroid management.
TBL: “Based on our base-case analysis of cost-effectiveness, short-term use of bevacizumab would be more favored than that of corticosteroids in the US at the willingness to pay threshold of $150,000/QALY.” | Lai, Pract Radiat Oncol 2024