ONCAlert | 2017 San Antonio Breast Cancer Symposium
Colorectal Cancer Case Studies

Charles Fuchs, MD: Bevacizumab Side-Effects

Charles Fuchs, MD
Published Online:Apr 27, 2016
Case 1 examines a 68-year-old man was diagnosed with advanced, unresectable colon cancer has just started treatment with FOLFIRI plus bevacizumab.

Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 1

Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 1
Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 2
Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 1
Unresectable Colon Cancer with Charles Fuchs, MD and Tanios Bekaii-Saab, MD: Case 2


What side effects can be expected with bevacizumab, and which are most common and bothersome to patients? What serious side effects might occur with bevacizumab?

For the most part, bevacizumab is exceptionally well-tolerated. The notable toxicity that we already recognize is hypertension, namely modest elevation in blood pressure typically occurring over the course of weeks to months of administration. Nothing we see immediately after administration of the drug. Moreover, that's normally well-treated with any of the standard oral anti-hypertensive medications. I often use the ACE inhibitors in conjunction with patients who get hypertension, but ultimately the rates of patients who get hypertension are 10% of patients, 20% at most, but easily treated with standard remedies.

Beyond hypertension, there are some things to look out for. Proteinuria can occur early in patients who are on bevacizumab for months, so it is recommended you check urine for protein periodically, but the rates of proteinuria are pretty low. The only circumstance to which you would likely discontinue bevacizumab would be if there were 3+ proteinuria, and even then you could restart if the proteinuria diminishes again.

You need to be aware of the rare finding of a fistula or a perforation that can happen in conjunction with bevacizumab. Cardiovascular events, which have been rarely reported with bevacizumab, I mean less than 3% of cases having those types of events have been reported, but I rarely see that happening and it doesn't deter me from  using it. So for the most part, patients are completely unaware that you've even added bevacizumab to their chemotherapy because it has such a little effect on quality of life.

Unresectable Colon Cancer: Case 1

68-year-old man was diagnosed with advanced, unresectable colon cancer has just started treatment with FOLFIRI plus bevacizumab.

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