title: Management of venous thromboembolism in colorectal cancer patients treated with bevacizumab.
abstract: Venous thromboembolism associated with use of a central venous access system is an urgent problem in patients treated with bevacizumab (bev). We investigated the effectiveness of Doppler ultrasound imaging (DUS) in the early detection of catheter-related thrombosis for avoidance of severe venous thromboembolism. Patients with metastatic colorectal cancer received either FOLFOX-4 + bev or FOLFIRI + bev. DUS was performed on the deep venous system for detection of thrombus formation during the initial cycle of treatment, followed by re-evaluation after the third cycle in patients with asymptomatic thrombus formation. All patients were followed up until treatment was interrupted. Median duration of follow-up was 484 days (range 72-574). Among 41 enrolled patients, curable symptomatic thrombosis occurred in one, and asymptomatic thrombosis in 21 (51.2%). Of 21 patients undergoing re-evaluation, thrombi remained without progression in 17 patients, and enlargement in 4 patients. In two of the patients in whom there was progression, pulmonary embolism occurred after the sixth cycle. In the asymptomatic group, no thrombi developed as far as the superior vena cava in any patient. In the cases of progression, thrombotic enlargement was observed in all the 4 patients, with decreased vascular flow in 2. Using DUS, we were able to detect asymptomatic thrombosis in the early cycles of treatment, indicating its potential in the monitoring of venous thrombi. In the event of an enlarging asymptomatic thrombosis developing into the superior vena cava along with decreased vascular flow, careful follow-up and appropriate anticoagulant therapy may be recommended without increased risk of bleeding.
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan. m.suenaga@jfcr.or.jp
authors.forename: Mitsukuni
authors.initials: M
authors.lastname: Suenaga
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Mizunuma
authors.forename: Kokoro
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Eiji
authors.initials: E
authors.lastname: Shinozaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsusaka
authors.forename: Keisho
authors.initials: K
authors.lastname: Chin
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kuboki
authors.forename: Takashi
authors.initials: T
authors.lastname: Ichimura
authors.forename: Masato
authors.initials: M
authors.lastname: Ozaka
authors.forename: Mariko
authors.initials: M
authors.lastname: Ogura
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Matsueda
authors.forename: Fumio
authors.initials: F
authors.lastname: Konishi
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Hatake
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000150:complications / Q000188:drug therapy*; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D019851:Thrombophilia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D018608:Ultrasonography, Doppler; D014683:Vena Cava, Superior; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D009944:Organoplatinum Compounds; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
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