Avastin compromising the quality of MRI with contrast?

My husband was diagnosed in Jan 09 and we have completed the standard surgery, Temodar, radiation route, then moving to Avastin (before progression) and Temodar 5/23.  His October MRI seemed to show some initial signs of progression, although extremely limited and not responsive to contrast.  Our NO indicated that the use of Avastin makes the MRI with contrast not reliable due to the drug's interaction with blood flow.  Thus, he is saying that the progession may be worse than actually appearing because of the contrast not being effective in highlighting the progressed areas.  Our neurosurgeon, and an outside email from our contact at Duke, seem to not believe this side effect of Avastin.  Has anyone heard of this side effect before or discussed it with your physicians?

 

Thank you!

 

 

Never heard of this.  When my husband had progression it was clear with contrast even when he was on Avastin.  I'd go with the Duke guy and the NS.  Anyone else you can ask.  What does radiologist say?

Take care,

Peace,

JMB

Have they done a PET scan?  That should show hypermetabolic activity and the degree of progression.

Just a thought.

Good luck and God Bless

I agree with Chessie.  PET scans check things on the cellular level and reveal activity or lack thereof.  We went to Duke for treatment and that's what they ordered.  Good luck and take care.

janni

Our NO advised that PET scans are not reliable enough to rule out progression.  He said he would do one if we insisted but recent findings had questions the accuracy of PET scans in this case due to the blood brain barrier.  He said that if we had a PET scan and it confirmed progression, we would be changing treatment but that if we had one and it failed to confirm progression, he would not be confident enough in such findings to not change treatment.  So the best it could do was confirm progression.

I have heard that Avastin restricts the blood flow to the tumor and that it may be there but isn't getting blood so therefore can't be seen.  I wish I could remember where I read that.

Our NO was at Duke when they did all the studies on Advastin, she said they would see these clear MRI's and yet the patient would have worsening symptoms.  What they found was the Flair and T-2 images would show where there was most likely progression, but most Drs do not look at these images.  My husband had these wavy things on the Flair and the T-2 and the normal mri looked great, but he was sleeping most of the time.  She changed his treatment, next one, more of the wavy and 2 new spots on the other side, changed treatment, next month MRI the spots were bigger and since they are on the opposite side, the treatments jusst aren't working.  So, look at symptoms, Advastin can skew the MRI.

 

On 10/21/2009 abh828 wrote:

Our NO advised that PET scans are not reliable enough to rule out progression.  He said he would do one if we insisted but recent findings had questions the accuracy of PET scans in this case due to the blood brain barrier.  He said that if we had a PET scan and it confirmed progression, we would be changing treatment but that if we had one and it failed to confirm progression, he would not be confident enough in such findings to not change treatment.  So the best it could do was confirm progression.

I've never heard of such a thing.  If it were me I would INSISTon the PET scan.  Although the PET is not 100% due to other issues like inflammation, my onc orders one every 3 months with PET/CT contrast and that's what he goes by. 

What you want is to see if it does confirm progression so that the treatment can be changed.  If there is no progression, you would stay with what is perceived to be working and there would be no reason to change.  That's only common sense. 

As to the blood/brain barrier, that shouldn't even enter the picture.  That would come in to play if there were suspected brain mets.  And then they would do an MRI of the brain independent of other scans.  There are very few treatments that cross the blood/brain barrier; mainly Tarceva. 

And if this doctor refuses to do the PET/CT with contrast, I'd be looking for another doctor.  I've been treated with tarceva for 3 years now and still going strong.  No mets and no progression since original diagnosis and all but a small part of one tumor is left; all others are totally gone.

Good luck and God Bless.

Yes, Avastin does compromise mri's. Unfortunatly, we are experiencing this very thing.

Just Monday, my husband had an mri and all of the sudden there it was, an"area" looks like infiltration- cloudy (forming cancer cells)and it appeared to be large even larger than the original diagnoses.

Our NO showed us the mri's back to May and he refered to it as an area of concern that were keeping an eye on. May -Aug - now. BIG difference. Dr.did mention that Avastin makes the mri's hard to read. Same thing someone else mentioned, the contrast is not as affective for highlighting.

My husband was having signs of decline. short term memory, word finding and fatique. I chalked it up to long term Temador and Avastin.(22 months of it) not the case. Now we are left with no real options.

On Nov. 2nd, he will be screened for a new trial XL184. It shows some minor improvemnent for some patients,but too early in the study for numbers. He will be part of the study primiarily to provide research of the side effects of the medication.

L

 

On 10/21/2009 abh828 wrote:

My husband was diagnosed in Jan 09 and we have completed the standard surgery, Temodar, radiation route, then moving to Avastin (before progression) and Temodar 5/23.  His October MRI seemed to show some initial signs of progression, although extremely limited and not responsive to contrast.  Our NO indicated that the use of Avastin makes the MRI with contrast not reliable due to the drug's interaction with blood flow.  Thus, he is saying that the progession may be worse than actually appearing because of the contrast not being effective in highlighting the progressed areas.  Our neurosurgeon, and an outside email from our contact at Duke, seem to not believe this side effect of Avastin.  Has anyone heard of this side effect before or discussed it with your physicians?

 

Thank you!

 

 

What Tisha is saying is accurate. My husband has had progression in two ways.  One was two very tiny spots that did enhance and the other is low grade tumor that has continued to grow.  He has been on Avastin since March and the two spots have gone away with treatment, but the low grade tumor has continued to move along.  The Avastin keeps the low grade tumor from being "seen".  The only way to know that it is there is from the T2 and Flair images.  These have changed and like she said most radiologists do not look at that.  Our NO was trained at Duke as well and says that on Avastin, it can "skew" the reading of the low grade...that is why the T2 and Flair needs to be looked at carefully.  Avastin cuts off the blood supply of the tumor and that does affect how the MRI looks.