title: Management of bevacizumab-associated bowel perforation: a case series and review of the literature.
abstract: BACKGROUND
  This study examined the various approaches to the management of perforation and the associated outcomes in patients with bevacizumab-associated bowel perforation at a tertiary cancer center.
  
  
  METHODS
  Our institutional pharmacy database was searched to identify all patients who had received bevacizumab over a 2-year period (January 2004 to October 2006). Medical records of these patients were examined for reports of confirmed bowel perforation or fistula, associated clinicopathological factors, treatment, and outcomes.
  
  
  RESULTS
  We identified 1442 patients who had been treated with bevacizumab over the study period with perforation occurring in 24 (1.7%). The breakdown of these 24 patients by disease site was as follows: ovarian (3 of 50, 6%), gastroesophageal (2 of 38, 5.3%), pancreatic (7 of 141, 5%), unknown primary (1 of 60, 1.7%), lung (1 of 67, 1.5%), colorectal (6 of 478, 1.3%), and renal cell (4 of 269, 1.5%). The majority of patients (n = 19, 79%) were initially managed nonoperatively. Only five (21%) patients ultimately underwent surgical exploration, with a subsequent anastomotic leak developing in one patient. The overall 30-day mortality rate was 12.5%.
  
  
  CONCLUSIONS
  Bevacizumab-associated bowel perforation occurs in patients with various malignancies, with an incidence of 1.7%. Nonoperative treatment is a viable approach to management in selected patients.
authors.affiliation: Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: B D
authors.initials: BD
authors.lastname: Badgwell
authors.forename: E R
authors.initials: ER
authors.lastname: Camp
authors.forename: B
authors.initials: B
authors.lastname: Feig
authors.forename: R A
authors.initials: RA
authors.lastname: Wolff
authors.forename: C
authors.initials: C
authors.lastname: Eng
authors.forename: L M
authors.initials: LM
authors.lastname: Ellis
authors.forename: J N
authors.initials: JN
authors.lastname: Cormier
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality; D015996:Survival Rate
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab