Bevacizumab in Hereditary Hemorrhagic Telangiectasia

Abstract

To the Editor: Bose et al. (May 14 issue) 1 report on a patient with hereditary hemorrhagic telang-iectasia (HHT) who was treated with bevacizu-mab for epistaxis. Our patient was a 55-year-old man with HHT (endoglin mutation P.LYS402.FS) with intractable pain and frequent episodes of pancreatitis related to pancreatic arteriovenous malformations. Surgery and embolization were not feasible. An indium-111–labeled bevacizumab single-photon-emission computed tomographic (CT) scan 2 showed elevated tracer uptake in the arteriovenous malformations. Bevacizumab at a dose of 5.0 mg per kilogram of body weight every 2 weeks was started 1 year ago. This treatment immediately stopped the epistaxis, the skin vas-cular signs became less pronounced, and the fre-quency and severity of pancreatitis diminished. After 5 months, the dose was increased to 7.5 mg per kilogram every 2 weeks. Thereafter, morphine and tube feeding could be discontinued, and the patient resumed work. No change in the volume of the arteriovenous malformations was observed on CT. The patient still receives bevacizumab.