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Ambiguous effects of anti-VEGF monoclonal antibody (bevacizumab) for POEMS syndrome
  1. Yukari Sekiguchi1,
  2. Sonoko Misawa1,
  3. Kazumoto Shibuya1,
  4. Saiko Nasu1,
  5. Satsuki Mitsuma1,
  6. Yuta Iwai1,
  7. Minako Beppu1,
  8. Setsu Sawai1,
  9. Shoichi Ito1,
  10. Shigeki Hirano1,
  11. Chiaki Nakaseko2,
  12. Satoshi Kuwabara1
  1. 1Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
  2. 2Department of Haematology, Graduate School of Medicine, Chiba University, Chiba, Japan
  1. Correspondence to Dr Satoshi Kuwabara, Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; kuwabara-s{at}faculty.chiba-u.jp

Abstract

Objective Vascular endothelial growth factor (VEGF) plays an essential role in the pathophysiology of polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes (POEMS) syndrome. Anti-VEGF antibody (bevacizumab) appears to be an attractive therapeutic option. The aim of this study is to investigate the effects of bevacizumab for patients with POEMS syndrome.

Methods We reported six POEMS patients treated with bevacizumab and reviewed the literature.

Results The serum VEGF levels decreased immediately after bevacizumab administration in all six patients. However, four patients had entirely no clinical response, and two of them died. The remaining two showed improvement that could be explained by combined treatments. We also reviewed the literature and found 11 patients treated with bevacizumab; of these, only one was treated with bevacizumab alone. 10 had combined treatments, and four died without any response.

Conclusions Both our experience and the literature suggest ambiguous effects of bevacizumab; inhibition of VEGF alone may be insufficient because multiple cytokines are upregulated, or aberrant neo-vascularization may have already fully developed in the advanced stage of POEMS syndrome.

  • Haematology
  • Neuropathy

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