Bevacizumab-induced nasal septal perforation: Incidence of symptomatic, confirmed event(s) in colorectal cancer patients

Abstract

Purpose In breast cancer patients, Mailliez and others described that 5 of 70 patients (7%) developed a bevacizumab-induced nasal septal perforation. However, to date, no studies have reported such rates in colorectal cancer patients, who derive a survival advantage with this drug. Methods This study examined the incidence of bevacizumab-induced, clinically symptomatic, otolaryngology specialist-confirmed nasal septal perforation among 100 patients who had been consecutively-treated for metastatic colorectal cancer. Results The incidence of nasal septal perforation was 1% (95% confidence intervals: −0.95% to 2.95%). This single adverse event was successfully managed conservatively. Within the whole group, 94 had been treated with bevacizumab at 5 mg/kg every two weeks, except for four patients treated at higher doses. The median number of bevacizumab doses (range) was seven (1–96). Concomitant chemotherapy had been prescribed to all patients, consisting of oxaliplatin, 5-fluorouracil, leucovorin, as per one of the FOLFOX regimens (44 patients); irinotecan, 5-fluorouracil, leucovorin, as per the FOLFIRI regimen (13 patients); both these regimens and no other (five patients); or a different regimen (38 patients). Conclusion Nasal septal perforation from bevacizumab occurs infrequently among colorectal cancer patients.

Modulation of Bevacizumab-Induced Toxicity for Cultured Human Corneal Fibroblasts

“…[15][16][17] Our previous reports showed a loss of epithelial integrity; subsequently, without discontinuation of bevacizumab application, thinning of the stromal layer progressed further. 19 Most adverse reactions were observed in patients who demonstrated apparent reduction of corneal NV in response to the treatment. The corneas with stable NV without inflammatory signs usually did not show antiangiogenic changes or adverse reactions in response to anti-VEGF therapy.…”

“…Though the incidence of significant adverse reactions is not high, tissue impairment is reported to occur regardless of the diseased organ or unrelated normal tissue as in perforation of the nasal septum. 19,20 Angiogenesis is a critical process in wound healing. Therefore, inhibition of VEGF would be expected to interfere with the wound healing process.…”

Spontaneous nasal perforation in a bevacizumab-treated patient with metastatic breast cancer

“…However, nasal septum perforation is rare, and its association with bevacizumab use has been only described in a few cases in the literature . Prospective studies confirm that nasal septal perforation from bevacizumab occurs infrequently both in colorectal cancer patients and other solid tumors with an incidence of about 1%‐2% . Our case report is a new case reported in a metastatic breast cancer patient.…”

Bowel Perforation Following Continuation of Bevacizumab Post Nasal Septal Perforation―A Case Report

“…Patients may experience noisy nasal airflow and/or epistaxis. It may be an under-reported adverse event, as not all patients receiving bevacizumab therapy, who experience epistaxis, have assessment by ENT [4].…”