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PET response and tumor stabilization under erlotinib and bevacizumab treatment of an intracranial lesion non-invasively diagnosed as likely chordoma
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
2011 (English)In: Clinical Neuropathology, ISSN 0722-5091, Vol. 30, no 5, 242-246 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Chordoma is a rare and a slow-growing tumor originating from the notochord and commonly localized in the skull base. Surgery and occasionally radiotherapy have emerged as the treatments of choice. In the relapsed situations available treatment options are strictly limited; however, recently molecularly targeted agents have been proposed to be of potential beneficial value.

THE CASE: A 63-year-old male presenting with seizures and an extradural mass in the left brain hemisphere. An attempt to resect the tumor was followed by severe bradycardia when manipulating with the dura and therefore discontinued. It was considered too hazardous even to take a biopsy specimen. The tumor was considered radiologically and macroscopically as a chordoma. As the tumor progressed after radiotherapy, chemotherapy with erlotinib in combination with cetuximab was initiated. This treatment was interrupted due to progressive disease and toxicity. However, combination treatment with erlotinib and bevacizumab normalized the uptake of [11C]methionine PET signal and resulted in a slight tumor shrinkage on MRI. The patient is still (March 2011) free of symptoms, without cranial nerve deficits or seizures.

DISCUSSION: This report shows that erlotinib and bevacizumab in combination may completely quench the transport of the essential amino acid methionine to a treatment refractory intracranial tumor bearing radiological and clinical characteristics of a chordoma. Further studies are necessary to establish this strategy as a treatment option for this indication.

Place, publisher, year, edition, pages
2011. Vol. 30, no 5, 242-246 p.
Keyword [en]
chordoma, erlotinib, bevacizumab
National Category
Research subject
URN: urn:nbn:se:uu:diva-159947DOI: 10.5414/NP300371ISI: 000295355100005PubMedID: 21955928OAI: oai:DiVA.org:uu-159947DiVA: diva2:447496
Available from: 2011-10-12 Created: 2011-10-12 Last updated: 2011-10-26Bibliographically approved

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