title: Clinical predictors of bevacizumab-associated gastrointestinal perforation.
abstract: OBJECTIVE
  Bevacizumab is a generally well-tolerated drug, but bevacizumab-associated gastrointestinal perforations (BAP) occur in 0 to 15% of patients with ovarian carcinoma. Our goal was to evaluate the clinical predictors of BAP in order to identify factors, which may preclude patients from receiving treatment.
  
  
  METHODS
  We conducted a review of patients with recurrent epithelial ovarian carcinoma treated with bevacizumab between 2006 and 2009. Demographic and treatment data were collected for statistical analysis.
  
  
  RESULTS
  Eighty-two patients were identified; perforation occurred in 8 (9.76%). Among patients with perforation, a significantly higher incidence of prior bowel surgeries (p=0.0008) and prior bowel obstruction or ileus (p<0.0001) were found compared to non-perforated patients. The median age at onset of bevacizumab in the perforated group was 3 years younger (60 vs. 63 years, p=0.61). The incidence of thromboembolic events, GI comorbidities, number of prior chemotherapies, and body mass index were similar between the groups. None of the patients in the perforated group developed grade 3 or 4 hypertension, compared to a 32.4% incidence among the non-perforated patients (p=0.09). Upon multivariate analysis, when controlled for age greater or less than 60, prior bowel surgery, obstruction/ileus, and grade 3 or 4 hypertension, only the presence of obstruction/ileus was noted to be a significant predictor of perforation (p=0.04).
  
  
  CONCLUSIONS
  Predicting BAP remains a challenge. Bowel obstruction or ileus appears to be associated with increased risk of BAP.
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
authors.forename: Janos L
authors.initials: JL
authors.lastname: Tanyi
authors.forename: Georgia
authors.initials: G
authors.lastname: McCann
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Hagemann
authors.forename: George
authors.initials: G
authors.lastname: Coukos
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Rubin
authors.forename: John B
authors.initials: JB
authors.lastname: Liao
authors.forename: Christina S
authors.initials: CS
authors.lastname: Chu
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D045823:Ileus / Q000150:complications; D007416:Intestinal Perforation / Q000139:chemically induced; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy; D010051:Ovarian Neoplasms / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab