Incidence and management of bevacizumab-associated gastrointestinal perforations in patients with recurrent ovarian carcinoma

John P. Diaz, William P. Tew, Oliver Zivanovic, Jason Konner, Paul J. Sabbatini, Lisa A. dos Santos, Nadeem R. Abu-Rustum, Dennis S. Chi, Carol Aghajanian, Richard R. Barakat

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Objective: The objective of this study was to examine the incidence and management of bevacizumab-associated gastrointestinal (GI) perforations in patients with recurrent ovarian carcinoma. Methods: We identified all patients who received bevacizumab off protocol from August 2004-August 2008. We examined their medical records for reports of confirmed GI perforation, associated clinicopathological factors, treatment, and outcomes. Results: Six (4%) of 160 patients with ovarian carcinoma who had been treated with bevacizumab developed GI perforations, with a median of 4 (range, 2-8) previous cytotoxic regimens. The median serum CA-125 at the start of treatment was 228 U/mL (range, 50-3106 U/mL). The median number of bevacizumab cycles prior to perforation was 10.5 (range, 2-20). The median time from the last bevacizumab dose to diagnosis of GI perforation was 13 days (range, 1-28 days). Four (67%) patients underwent an exploratory surgery. At laparotomy, one had a gastric perforation and one had an appendiceal perforation; the site of perforation could not be identified in the other 2 Two patients (33%) were managed conservatively-one with a PEG tube and the other with supportive care. The median time of death from the date of diagnosis of GI perforation was 27 days (range, 4-326 days). Only two patients-one with a gastric and the other with an appendiceal perforation-survived > 65 days. The 30-day mortality rate following a bevacizumab-associated GI perforation was 50%. Conclusion: Bevacizumab-associated GI perforations in patients with recurrent ovarian carcinoma occurred in 4% of our patients. The prognosis of patients diagnosed with bevacizumab-associated GI perforations in this study was poor, and treatment should be individualized.

Original languageEnglish (US)
Pages (from-to)335-339
Number of pages5
JournalGynecologic oncology
Volume116
Issue number3
DOIs
StatePublished - Mar 1 2010

Keywords

  • Avastin
  • Bevacizumab
  • Gastrointestinal perforations
  • Ovarian cancer
  • Ovary
  • Recurrence

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

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    Diaz, J. P., Tew, W. P., Zivanovic, O., Konner, J., Sabbatini, P. J., dos Santos, L. A., Abu-Rustum, N. R., Chi, D. S., Aghajanian, C., & Barakat, R. R. (2010). Incidence and management of bevacizumab-associated gastrointestinal perforations in patients with recurrent ovarian carcinoma. Gynecologic oncology, 116(3), 335-339. https://doi.org/10.1016/j.ygyno.2009.11.017