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Cancer drug may help treat chronic nosebleeds

March 4, 2010 12:00:00 AM PST
Imagine having a nosebleed every day of your life but instead of a few drops, it's a few pints of blood. That's reality for people with Hereditary Hemorrhagic Telangiectasia (HHT), a genetic disorder that affects blood vessels.HHT impacts one out of every 2,000 people in the United States. Now one San Diego doctor is experimenting with a spray to stop the bleeding.

Jack Sardisco, 63, has been dealing with chronic nosebleeds since he was young.

"I'm talking about full-sized bath towels, you know, getting six or seven full-size bath towels full of blood," said Sardisco. "I was on the ground on the floor of the bathroom, like that close from passing out."

HHT is a genetic disorder of the blood vessels. There are laser treatments for the disease, but they don't last. "We didn't have a treatment. All we had was something to put a band-aid on it," said Terence M. Davidson, MD, professor of surgery and director of the UC San Diego Nasal Dysfunction Clinic.

Dr. Davidson is trying an off-label approach. He's using a cancer drug in low doses to stop the bleeding. The drug stops new blood vessel growth.

"All of a sudden, I was getting complete control for two years," said Dr. Davidson.

In a study, Dr. Davidson used Avastin on 10 patients. Injections, which require surgery and anesthesia, controlled bleeding for up to two years, while a nose-spray form worked for four months. In three years, he's used the treatment on more than 50 patients in all and seen no side effects.

"Never in my life have I been able to treat people from a nosebleed a day, and now all of a sudden, that's routine," said Dr. Davidson.

Sardisco comes into the office for a dose of the spray every couple of months. He's had one nosebleed in seven months -- one of his best years so far.

"I'm really hopeful that I can live my life, a normal life," said Sardisco.

The cancer drug is FDA approved to treat colon cancers, but is not approved for this use. Doctors have also used it successfully off-label to treat eye disorders.

Dr. Davidson says because the treatment is still considered clinical research, patients cannot get a prescription for the nose spray to use at home.

Extra Information on HHT:

BACKGROUND: Hereditary Hemorrhagic Telangiectasia, or HHT, is a genetic disorder of the blood vessels. According to the University of California, San Diego, it affects about one in 2,000 people. The disorder is also referred to as Osler-Weber-Rendu after several doctors who studied HHT about 100 years ago. In 1896, HHT was first described as a hereditary disorder involving nosebleeds and characteristic red spots that was distinctly different from hemophilia.

TRADITIONAL APPROACH DOESN'T ALWAYS WORK: The nosebleeds caused by HHT sometime respond to everyday practical treatments at home. Patients can try humidification of the air and use of ointments on the lining of the nose to keep the nose moist. If these remedies don't work, the first medical treatment is usually laser therapy. A small beam is directed around the margins of each telangiectasia, and the treatment typically needs to be repeated periodically. "We didn't have a treatment at all really," Terence Davidson, M.D., director of the UCSD Nasal Dysfunction Clinic in San Diego, Calif., told Ivanhoe. "All we had was something to put a Band-Aid on and hold pressure on it."

NEW APPROACH: Dr. Davidson is testing a new approach to treatment of HHT. He's using the cancer drug Avastin in low doses in both injection and spray forms to stop the nosebleeds. "I have had phenomenal results," Dr. Davidson said. "Never in my life have I been able to treat people [with] a nosebleed a day, and now all of a sudden, that's routine." In injection form, the drug needs to be administered under anesthesia. In spray form, the patient comes to the doctor's office every few months to get a dose. In one study, a shot of Avastin controlled nosebleeds for up to two years. In spray form, it stopped nosebleeds for up to four months. Dr. Davidson has used the treatment on 50 patients over the past three years and hasn't seen any adverse side effects. He says there is a chance that the drug can interfere with wound healing. Right now, Avastin for nosebleeds is still considered clinical research, so patients cannot get a prescription for the spray and use the drug at home.

Avastin is a cancer drug used to treat colon cancer; non-squamous, non-small cell lung cancer, metastatic breast cancer; glioblastoma and renal cell carcinoma. It is designed to inhibit angiogenesis, the process by which new blood vessels develop.

Jacqueline Carr
UCSD Media Relations
(619) 543-6163