ONCAlert | 2018 SGO Annual Meeting on Women’s Cancer
Colorectal Cancer Case Studies

Tanios Bekaii-Saab, MD: Bevacizumab Side-Effects

Tanios Bekaii-Saab, MD
Published Online:Apr 26, 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?

Bevacizumab is essentially an agent that blocks VEGF. Its toxicities are mostly related to blocking VEGF, so the way I call its toxicities is that they're mostly silent toxicities. They don't manifest themselves the way they would with chemotherapy or EGFR inhibitors, meaning the patient doesn't exhibit them per se. They're limited to hypertension, and in about 12% of patients the hypertension will require medications. You would use oral hypertensives and 99% of patients would have their blood pressure controlled this way.

Issues with wound healing, so if the patient needs emergency surgery that's something to think about. If it's an elective surgery, then you just wait 4 weeks after the last dose of bevacizumab, and some prefer 6 to 8 weeks before you do the surgery, and then you start it again 4 weeks after the surgery. There's also the risk of perforation in 1% or 2% of all patients, and that risk should stop the patient from receiving bevacizumab. There is also the risk of proteinuria, or shedding proteins through the urine, but for the overwhelming majority of the patients it's not that significant.

Overall, bevacizumab itself does not seem to worsen the chemotherapy toxicities. As I said, it doesn't have its own visible toxicities. Most of its toxicities seem to be related to the VEGF-inhibitory effect. One serious side effect is arterial and thromboembolic events, like a stoke. These usually occur in patients that are older or are at significant risk for these disorders, and patients who had myocardial infarction within 6 to 12 months. For those patients you just wouldn't administer bevacizumab.

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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