Brain interwoven with light threads, symbolizing targeted cancer therapy.

BNCT and Bevacizumab: A Promising Duo in Recurrent Glioma Treatment?

Mira Elwood in Health & Wellness August 2025 • 4 min read.

"Exploring a pilot study on combining boron neutron capture therapy (BNCT) with bevacizumab for recurrent malignant gliomas."

Recurrent malignant gliomas (RMGs) pose a significant challenge in oncology, with limited effective treatment options available. Boron neutron capture therapy (BNCT), a targeted radiation therapy, has shown promise, but can lead to brain radiation necrosis (BRN) as a side effect. This necrosis can cause severe neurological complications, diminishing the benefits of the treatment.

To combat BRN, researchers have explored the use of bevacizumab (BV), an anti-VEGF antibody known for its ability to reduce edema and inflammation. A recent pilot study investigated the combination of BNCT with early, successive BV treatments to mitigate BRN and improve outcomes for RMG patients.

This article delves into the findings of this pilot study, examining the feasibility, efficacy, and BRN control achieved by combining BNCT and bevacizumab. We will explore the potential of this combination therapy to extend survival and improve the quality of life for individuals battling recurrent malignant gliomas.

How Does Combining BNCT and Bevacizumab Work?

Brain interwoven with light threads, symbolizing targeted cancer therapy.

The pilot study involved seven patients with recurrent malignant gliomas who underwent BNCT followed by a course of bevacizumab treatments. BNCT works by selectively targeting tumor cells with a boron compound and then irradiating them with neutrons, leading to cell death. Bevacizumab, administered shortly after BNCT, aims to counteract the development of BRN by inhibiting VEGF, a key factor in edema formation and inflammation.

The study assessed several key outcomes:

Feasibility: Evaluating the occurrence of adverse events associated with the combined treatment.
Efficacy: Measuring overall survival (OS) and progression-free survival (PFS) to determine the treatment's impact on disease progression.
BRN Control: Assessing the ability of the combination therapy to prevent or manage brain radiation necrosis.

The results showed a median overall survival (OS) of 15.1 months and a median progression-free survival (PFS) of 5.4 months. While one patient experienced uncontrollable brain edema after BV interruption due to meningitis, and two others showed symptomatic BRN aggravation after BV interruption, the remaining patients did not exhibit BRN during the observation period. Common adverse events included grade 2 and 3 proteinuria, which sometimes necessitated BV treatment interruption.

The Future of RMG Treatment: A Glimmer of Hope

This pilot study suggests that combining BNCT with early bevacizumab treatments can effectively prevent or control BRN, prolong overall survival, and maintain an acceptable incidence of adverse events in patients with recurrent malignant gliomas. These findings offer a promising avenue for improving treatment outcomes in this challenging patient population.

The study authors emphasize the need for further research to validate these preliminary results and optimize the treatment protocol. A prospective clinical trial is currently underway to investigate BNCT and simultaneous BV treatments for poor prognosis patients with recurrent malignant glioma, potentially solidifying this combination therapy as a new standard of care.

While the results are promising, it's important to note the small sample size of the study. Larger, multi-center trials are needed to confirm these findings and determine the optimal dosage and timing of bevacizumab in conjunction with BNCT. The future of RMG treatment may very well depend on innovative combinations like this, offering renewed hope for patients and their families.

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This article is based on research published under:

DOI-LINK: 10.2176/nmc.oa.2018-0111, Alternate LINK

Title: Boron Neutron Capture Therapy Combined With Early Successive Bevacizumab Treatments For Recurrent Malignant Gliomas – A Pilot Study

Subject: Neurology (clinical)

Journal: Neurologia medico-chirurgica

Publisher: Japan Neurosurgical Society

Authors: Hiroyuki Shiba, Koji Takeuchi, Ryo Hiramatsu, Motomasa Furuse, Naosuke Nonoguchi, Shinji Kawabata, Toshihiko Kuroiwa, Natsuko Kondo, Yoshinori Sakurai, Minoru Suzuki, Koji Ono, Shiro Oue, Eiichi Ishikawa, Hiroyuki Michiue, Shin-Ichi Miyatake

Published: 2018-01-01

Everything You Need To Know

What is Boron neutron capture therapy (BNCT), and how does it work?

Boron neutron capture therapy (BNCT) is a targeted radiation therapy. It involves administering a boron compound that is preferentially taken up by tumor cells. Subsequently, the patient undergoes neutron irradiation. The neutrons interact with the boron, producing high-energy alpha particles that kill the tumor cells. This method is designed to be highly specific, targeting cancer cells while sparing surrounding healthy tissue. However, a potential side effect is brain radiation necrosis (BRN).

What is the role of bevacizumab (BV) in this treatment approach?

Bevacizumab (BV) is an anti-VEGF antibody used to counteract brain radiation necrosis (BRN). Its mechanism involves inhibiting VEGF, which is a key factor in edema formation and inflammation within the brain. By reducing edema and inflammation, bevacizumab helps mitigate the damage caused by BNCT, potentially preventing severe neurological complications and improving patient outcomes in recurrent malignant gliomas (RMGs). The anti-VEGF action helps to control the inflammation and edema that can lead to adverse neurological effects.

How was the combination of Boron neutron capture therapy (BNCT) and bevacizumab (BV) used in the pilot study?

The pilot study combined Boron neutron capture therapy (BNCT) and bevacizumab (BV) to address the challenge of recurrent malignant gliomas (RMGs). The study's approach involved using BNCT, which targets tumor cells with a boron compound followed by neutron irradiation. Immediately following this, patients received bevacizumab, which is an anti-VEGF antibody, to counteract the development of brain radiation necrosis (BRN). The study aimed to assess the feasibility, efficacy, and BRN control achieved by combining these two treatments in patients with RMGs.

What specific outcomes were assessed in the pilot study?

The pilot study evaluated the combination of Boron neutron capture therapy (BNCT) and bevacizumab (BV) by assessing three main areas: feasibility, efficacy, and brain radiation necrosis (BRN) control. Feasibility focused on whether the combined treatment was manageable, looking at the adverse events. Efficacy measured overall survival (OS) and progression-free survival (PFS) to understand how the treatment affected disease progression. BRN control assessed the combination therapy's ability to prevent or manage brain radiation necrosis, a significant side effect of BNCT.

What are the key takeaways from the study's findings regarding the combination of BNCT and bevacizumab (BV)?

The findings suggest that combining Boron neutron capture therapy (BNCT) with early bevacizumab (BV) treatments can effectively prevent or control brain radiation necrosis (BRN). The study showed a median overall survival (OS) of 15.1 months and a median progression-free survival (PFS) of 5.4 months. While some patients experienced adverse events, the majority did not exhibit BRN during the observation period. This indicates a promising avenue for improving treatment outcomes and extending survival for patients battling recurrent malignant gliomas (RMGs).