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

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

Fingerprint

Carcinoma
Incidence
Stomach
Bevacizumab
Laparotomy
Medical Records
Mortality
Therapeutics
Serum

Keywords

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

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Diaz, J. P., Tew, W. P., Zivanovic, O., Konner, J., Sabbatini, P. J., dos Santos, L. A., ... 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

Incidence and management of bevacizumab-associated gastrointestinal perforations in patients with recurrent ovarian carcinoma. / Diaz, John P.; Tew, William P.; Zivanovic, Oliver; Konner, Jason; Sabbatini, Paul J.; dos Santos, Lisa A.; Abu-Rustum, Nadeem R.; Chi, Dennis S.; Aghajanian, Carol; Barakat, Richard R.

In: Gynecologic Oncology, Vol. 116, No. 3, 01.03.2010, p. 335-339.

Research output: Contribution to journalArticle

Diaz, JP, Tew, WP, Zivanovic, O, Konner, J, Sabbatini, PJ, dos Santos, LA, Abu-Rustum, NR, Chi, DS, Aghajanian, C & Barakat, RR 2010, 'Incidence and management of bevacizumab-associated gastrointestinal perforations in patients with recurrent ovarian carcinoma', Gynecologic Oncology, vol. 116, no. 3, pp. 335-339. https://doi.org/10.1016/j.ygyno.2009.11.017
Diaz, John P. ; Tew, William P. ; Zivanovic, Oliver ; Konner, Jason ; Sabbatini, Paul J. ; dos Santos, Lisa A. ; Abu-Rustum, Nadeem R. ; Chi, Dennis S. ; Aghajanian, Carol ; Barakat, Richard R. / Incidence and management of bevacizumab-associated gastrointestinal perforations in patients with recurrent ovarian carcinoma. In: Gynecologic Oncology. 2010 ; Vol. 116, No. 3. pp. 335-339.
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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.",
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