Improvement in Patient-reported Hearing After Treatment With Bevacizumab in People With Neurofibromatosis Type 2

Objective: Assess patient-reported outcomes (PRO) for hearing and tinnitus relative to clinical hearing assessment in people with neurofibromatosis 2 (NF2) associated hearing loss. Study Design: Prospective, open label, phase-II clinical trial with PRO administered pre-, post-, and after treatment. Setting: Three tertiary referral centers. Patients: Fourteen patients with NF2, median age of 30 years (range, 14–79 yr) and progressive hearing loss (median baseline word recognition score, 60%; range, 13–82%). Half of these patients achieved objective hearing response (word recognition score improved beyond the 95% critical difference versus baseline). Intervention: Bevacizumab 7.5 mg/kg was administered every 3 weeks for 48 weeks, followed by surveillance for 24 weeks off-drug. Main Outcome Measures: Speech, spatial, and qualities of hearing scale (SSQ) and tinnitus reaction questionnaire (TRQ) to assess hearing difficulties in life situations and tinnitus related distress. Results: Patient-reported speech understanding and auditory quality improved with bevacizumab treatment and were significantly correlated with word recognition scores, but not pure tone threshold average. There was no change in spatial perception after treatment. Reduction in tinnitus distress after treatment with bevacizumab did not reach statistical significance. Conclusion: Participants had reductions in hearing difficulty during treatment with bevacizumab, suggesting that patients subjectively experience hearing-related benefit mirroring clinical hearing assessments. We suspect the lack of significant reduction in tinnitus distress is related to small sample size and low intensity of distress in our sample. These data highlight the usefulness of PRO measures to assess benefits of treatment in the setting of NF2-associated hearing loss. Address correspondence and reprint requests to Scott R. Plotkin, M.D., Ph.D., Yawkey 9E, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; E-mail: splotkin@partners.org J.B. and S.P. have equal contribution to the article. Conflict of Interest and Sources of Funding: A.L.B. has received a salary from Ambry Genetics. B.C.W. had no conflict of interest to report. Her research is supported by the Intramural Research program of the Canter for Cancer Research, NCI. V.L.M. receives funding from the Program in Cancer Outcomes Research Training (NCI R25CA92203) and a Young Investigator's Award from the Children's Tumor Foundation. J.O.B. receives research funding from NIH, the Children's Tumor Foundation, the Galloway Foundation, the Neurofibromatosis Therapeutic Acceleration Program, and private compensation as a consultant for Abbvie Inc. S.R.P. receives research funding from Children's Tumor Foundation, NIH, and the Department of Defense Neurofibromatosis Research Program. He has consulted for Novartis. For the remaining authors, none were declared. Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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