Annals of Oncology Advance Access published online on November 16, 2007
Annals of Oncology, doi:10.1093/annonc/mdm508
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© 2007 European Society for Medical Oncology
Management of bevacizumab-associated bowel perforation: a case series and review of the literature
1 Department of Surgical Oncology
2 Department of Medical Oncology
3 Department of Cancer Biology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
* Correspondence to: Dr J. N. Cormier, Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: +1-713-792-6949; Fax: +1-713-745-1921; E-mail: jcormier{at}mdanderson.org
Background: This study examined the various approaches to the management of perforation and the associated outcomes in patients with bevacizumab-associated bowel perforation at a tertiary cancer center.
Patients and methods: Our institutional pharmacy database was searched to identify all patients who had received bevacizumab over a 2-year period (January 2004 to October 2006). Medical records of these patients were examined for reports of confirmed bowel perforation or fistula, associated clinicopathological factors, treatment, and outcomes.
Results: We identified 1442 patients who had been treated with bevacizumab over the study period with perforation occurring in 24 (1.7%). The breakdown of these 24 patients by disease site was as follows: ovarian (3 of 50, 6%), gastroesophageal (2 of 38, 5.3%), pancreatic (7 of 141, 5%), unknown primary (1 of 60, 1.7%), lung (1 of 67, 1.5%), colorectal (6 of 478, 1.3%), and renal cell (4 of 269, 1.5%). The majority of patients (n = 19, 79%) were initially managed nonoperatively. Only five (21%) patients ultimately underwent surgical exploration, with a subsequent anastomotic leak developing in one patient. The overall 30-day mortality rate was 12.5%.
Conclusions: Bevacizumab-associated bowel perforation occurs in patients with various malignancies, with an incidence of 1.7%. Nonoperative treatment is a viable approach to management in selected patients.
avastin, bevacizumab, complication, GI perforation, toxicity
Received for publication July 27, 2007. Revision received September 26, 2007. Accepted for publication October 1, 2007.
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