Safety and efficacy of metal stents for malignant colonic obstruction in patients treated with bevacizumab

Treatment option of endoscopic stent insertion or gastrojejunostomy for gastric outlet obstruction due to gastric cancer: a propensity score-matched analysis

“…Regarding colonic cancer, Imbulgoda A et al [28] reported that perforation rates after stenting were higher in patients undergoing chemotherapy with bevacizumab than in those undergoing chemotherapy without bevacizumab (20%, 2/20 vs. 6%, 3/47). In contrast, Lee et al [29] showed that the perforation rate after stenting was not higher in the bevacizumab group than in the non-bevacizumab group for malignant colonic obstruction. Iwasaki et al [30] reported that the use of an Ultraflex stent (odds ratio [OR] 6.81; 95% confidence interval [CI] 1.54-30.00; p = 0.011) and prior chemotherapy (OR 6.13; 95% CI 1.46-25.70; p = 0.013) correlated with stent-related complications in patients with malignant obstruction of the esophagus or gastric cardia.…”

Bevacizumab in patients treated with palliative colonic stent placement: Is it safe?

“…More data were recently published that pointed in the same direction as in the study by Lee et al 8 In a retrospective study that included a total of 353 patients who underwent colonic stent placement for obstructing metastasized colorectal cancer, the perforation rate in patients treated with (n Z 96) and without (n Z 257) bevacizumab was similar in both groups: 7.3% and 7.0%. 9 These findings give more credence to the safety of bevacizumab-based therapy in patients treated with palliative colonic stent placement.…”

“…In univariable analysis, there was no significant difference in the adverse event rates between the 2 groups, with a mean overall follow-up time of 316 days. 8 The results should be interpreted with some caution because the study was nonrandomized and involved a heterogeneous population, including patients with extracolonic malignancy (17%), right-sided obstruction (10%), and stents placed as bridge to surgery (4%), and different chemotherapy regimens were used. 8 In addition, the overall reported incidence rate of stent-related perforation of 2% (4 of 199 patients) was considerably lower than the incidence rates reported in the pooled and prospective literature, where stent-related perforation occurred in approximately 10% of patients treated with palliative colonic stent placement.…”

“…8 The results should be interpreted with some caution because the study was nonrandomized and involved a heterogeneous population, including patients with extracolonic malignancy (17%), right-sided obstruction (10%), and stents placed as bridge to surgery (4%), and different chemotherapy regimens were used. 8 In addition, the overall reported incidence rate of stent-related perforation of 2% (4 of 199 patients) was considerably lower than the incidence rates reported in the pooled and prospective literature, where stent-related perforation occurred in approximately 10% of patients treated with palliative colonic stent placement. 3,4 This suggests that the incidence rate in the study by Lee et al 8 was probably underestimated because of the retrospective study design and that the study was underpowered to demonstrate a noninferiority of bevacizumab-based therapy concerning stent-related perforation.…”

“…The literature on the risk of stent-related perforation after the initiation of first-line bevacizumab-based systemic therapy remains limited and contradicting. [7][8][9][10] In clinical practice, the potential risks of future bevacizumab therapy should not exclude endoscopic stent placement in the emergency treatment of life-threatening acute obstructing colonic cancer, particularly not when patients have an increased risk of mortality after emergency surgery owing to high age or severe comorbidities and when local expertise with colonic stent placement is available. After the acute obstruction is alleviated, the initiation of bevacizumabbased systemic therapy in the setting of a colonic stent can be a shared decision between patient and oncologist as they balance the potential benefits and harms for the individual patient.…”