title: Risk of arterial thromboembolic events in patients with advanced colorectal cancer receiving bevacizumab.
abstract: BACKGROUND
  Bevacizumab is an antiangiogenic mAb with efficacy against several cancers, but it is associated with risk of arterial thromboembolism (ATE). Further data are needed to determine the safety of bevacizumab.
  
  
  METHODS
  We recorded grade 3, 4, or 5 ATE events and other data (including age, baseline cardiovascular risk factors, history of ATE, and aspirin use) from 471 patients with metastatic colorectal cancer in the MAX (Mitomycin, Avastin, Xeloda) trial of capecitabine monotherapy versus capecitabine with bevacizumab with or without mitomycin C.
  
  
  RESULTS
  Bevacizumab-treated patients had 12 grade 3, 4, or 5 ATEs (3.8% incidence). ATEs occurred in 2.1% of patients >65 years, 5% of those with a history of ATE, and 5% of those with cardiac risk factors. Age, history of ATE, or vascular risk factors did not increase risk. Aspirin users had a higher incidence than nonusers (8.9% versus 2.7%) but had higher rates of vascular risk factors.
  
  
  CONCLUSIONS
  Bevacizumab was associated with a modestly higher risk of ATE, but safety was not significantly worse in older patients or patients with a history of ATE or vascular risk factors. The effect of aspirin in preventing ATE in patients receiving bevacizumab could not be determined from this study.
authors.affiliation: Department of Medical Oncology, Austin Health, Melbourne, Australia. niall.tebbutt@ludwig.edu.au
authors.forename: N C
authors.initials: NC
authors.lastname: Tebbutt
authors.forename: F
authors.initials: F
authors.lastname: Murphy
authors.forename: D
authors.initials: D
authors.lastname: Zannino
authors.forename: K
authors.initials: K
authors.lastname: Wilson
authors.forename: M M
authors.initials: MM
authors.lastname: Cummins
authors.forename: E
authors.initials: E
authors.lastname: Abdi
authors.forename: A H
authors.initials: AH
authors.lastname: Strickland
authors.forename: R M
authors.initials: RM
authors.lastname: Lowenthal
authors.forename: G
authors.initials: G
authors.lastname: Marx
authors.forename: C
authors.initials: C
authors.lastname: Karapetis
authors.forename: J
authors.initials: J
authors.lastname: Shannon
authors.forename: D
authors.initials: D
authors.lastname: Goldstein
authors.forename: S S
authors.initials: SS
authors.lastname: Nayagam
authors.forename: R
authors.initials: R
authors.lastname: Blum
authors.forename: L
authors.initials: L
authors.lastname: Chantrill
authors.forename: R J
authors.initials: RJ
authors.lastname: Simes
authors.forename: T J
authors.initials: TJ
authors.lastname: Price
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000068258:Bevacizumab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D001241:Aspirin