Bleeding after Bevacizumab Treatment in Patients with Metastatic Colorectal Cancer

Cao, Dan; Guo, Chunhong; Liu, Jie-Wei; Yang, Xi; Qiu, Li Xin

doi:10.5301/tj.5000211

Cited by 10 publications

(4 citation statements)

References 26 publications

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“…The incidence and the severity of these toxicities varies greatly across studies, however, bleeding stands out as the most severe and difficult to manage [9;10]. Among the anti-VEGF agents, bevacizumab retains the highest frequency of bleeding including epistaxis, hemoptysis, hematemesis, GI or vaginal bleeding, and brain hemorrhage [8;14]. …”

Section: Introductionmentioning

confidence: 99%

Safety of endoscopy in cancer patients on antiangiogenic agents: A retrospective multicenter outcomes study

et al. 2017

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Background/AimsThe use of antiangiogenic agents (AAs) in cancer treatment has increased because they offer survival benefit in combination with cytotoxic chemotherapy. Given their potential to cause gastrointestinal (GI) perforation and bleeding, it is currently recommended that AAs be held for 28 days before and after surgery. However, there are no specific guidelines which address their use around endoscopic procedures because data regarding the safety of endoscopy in cancer patients while on AAs is scarce despite the fact that these patients often require endoscopy. This study investigated the safety of endoscopy in cancer patients receiving AAs.MethodsThis is a retrospective multicenter study of a consecutive case series of 445 cancer patients undergoing endoscopy within 31 days of administration of AAs at 5 specialized cancer centers between April 2008 and August 2014. Endoscopies were classified into two different categories based on the risk of GI bleeding and perforation: low and high. The primary outcome measures were procedure-related adverse events (AEs) and death within 30 days of endoscopy. The severity of AEs was classified according to the common terminology criteria for adverse events (CTCAE) version 4.0. The incidence of AEs and mortality was calculated using the total number of patients as the denominator.Results445 cancer patients with a mean age of 54 years underwent a total of 545 endoscopies. Median time duration from AAs to endoscopy was 11 days. Of 545 endoscopic procedures, 398 (73%) were low-risk and 147 (27%) were high-risk. There were 3 procedure-related AEs: esophageal perforation (grade 3) two days after an EGD, pancreatitis (grade 5) a day after failed ERCP, and bleeding from the gastrostomy site (grade 1) two days after an EGD. Of 445 patients, 29 (6.5%) died within 30 days of the procedure with no deaths deemed procedure-related. The most common causes of death were terminal cancer (n = 10), hepatic decompensation (n = 5) and sepsis (n = 4).ConclusionIn this retrospective study, the rate of endoscopy-related AEs in patients on AAs appears to be low when performed in specialized cancer centers. However, future prospective studies are needed to confirm this finding.

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Section: Introductionmentioning

confidence: 99%

Safety of endoscopy in cancer patients on antiangiogenic agents: A retrospective multicenter outcomes study

et al. 2017

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“…In the hematological adverse event, the incidence of bleeding increased by adding bevacizumab to chemotherapy, but it was not statistically significant 7 , 8 , 11 , 12 , 20 , 21 . Some of the bleeding were clinically significant 7 , 8 but some were not 11 , 12 , 20 , 21 . Bleeding might be the effect of the anti-VEGF of bevacizumab, inhibiting coagulation and endothelial proliferation 7 .…”

Section: Discussionmentioning

confidence: 87%

Bevacizumab side effects and adverse clinical complications in colorectal cancer patients: review article

Minhajat,

Harjianti,

Islam

et al. 2023

Annals of Medicine &Amp; Surgery

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Objective: This review aimed to evaluate the effect of bevacizumab on adverse events and the quality of life (QoL) from colorectal cancer (CRC) patient. Methods: A literature search was conducted from PUBMED, MEDLINE databases and some valid literatures from another databases that published in the last 10 years, and the design is an observational and randomized controlled trial (RCT). Results: CRC is a malignancy, which happens in the colon or rectum. One of the therapy for CRC is by using bevacizumab, a monoclonal antibody. However, the usage of bevacizumab is still become a controversy because of its clinical complications. Several studies showed that bevacizumab could cause some adverse events in the cardiovascular, gastrointestinal, hematology, and others body systems and affect the CRC patient QoL. However, the clinical complication of this drug is also affected by the combination therapy regimen used. Conclusions: The use of bevacizumab could cause some adverse event in different aspects, including cardiovascular, gastrointestinal, hematology, and others. Some of those are significant, but others are not. Besides that, using bevacizumab as a treatment regiment could also affect the QoL of CRC patients, but it is also affected by the combination therapy regimen used.

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“…Tumor bleed can occur spontaneously but has also been associated with anti-angiogenic agents (e.g. bevacizumab) [6]. We hypothesize this patient’s bleed was precipitated by a rapid tumor shrinkage secondary to chemotherapy initiation.…”

Section: Discussionmentioning

confidence: 97%

Life-threatening Bleed Secondary to Tumor Shrinkage Effectively Palliated with Radiotherapy

Tseng¹,

Yew²,

Jeyasekharan³

et al. 2017

Cureus

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Inverted papilloma is a typically benign, but locally aggressive tumor arising from the nasal cavity and paranasal sinuses. Malignant transformation can occur in up to 10% of cases. Although spontaneous tumor bleeding can occur with malignancies, hemorrhage secondary to tumor shrinkage has not been reported. We present a patient with metastatic squamous cell carcinoma (from inverted papilloma) who developed a life-threatening bleed shortly after chemotherapy initiation. She was managed successfully with life-saving palliative radiotherapy (RT), delivered based on clinical markup. She was subsequently re-treated with highly conformal RT and chemotherapy to achieve a marked clinical response without surgery.

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Bleeding after Bevacizumab Treatment in Patients with Metastatic Colorectal Cancer

Cited by 10 publications

References 26 publications

Safety of endoscopy in cancer patients on antiangiogenic agents: A retrospective multicenter outcomes study

Safety of endoscopy in cancer patients on antiangiogenic agents: A retrospective multicenter outcomes study

Bevacizumab side effects and adverse clinical complications in colorectal cancer patients: review article

Life-threatening Bleed Secondary to Tumor Shrinkage Effectively Palliated with Radiotherapy

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