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

Charles Fuchs, MD: Experience With Patients on Bevacizumab Plus Chemotherapy

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 is your experience with patients who receive bevacizumab plus a CT regimen? What types of issues/side effects do they report with treatment?

As I say, the combination of any chemotherapy with bevacizumab is really well-tolerated, and the side effects that we'll see have been principally limited to the side effects that we experience with the chemotherapy. That is, bevacizumab doesn't really contribute to side effects. If a side effect occurs, it's going to be in the form of hypertension, which will arise a few months after starting and if that were the case, I wouldn't necessarily change the regimen, but I would certainly provide treatment like an ACE inhibitor for the hypertension, which is usually quite effective.

We do check urine proteins periodically for patients on chemotherapy plus bevacizumab, and were there to be significant elevations in proteinuria, that might be a circumstance to discontinue or suspend the use of bevacizumab. Frankly, even there that's so uncommon that I can't even remember the last time I had to do that. 

The only other consideration there is, is sometime we're giving this regimen for patients who may ultimately go on to get surgery like resection of a liver metastases, where a potentially curative surgical approach might follow in part because the response to chemotherapy was so good. If that were to happen, the other important consideration is you will want to hold the bevacizumab at least 4 weeks prior to surgery. So that in those circumstances, you may say "well, the last dose of chemotherapy you're going to receive before surgery will be chemotherapy without bevacizumab to reduce any complication from surgery."

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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