title: Predicting and managing the risk of pulmonary haemorrhage in patients with NSCLC treated with bevacizumab: a consensus report from a panel of experts.
abstract: BACKGROUND
  Bevacizumab is a monoclonal antibody against vascular endothelial growth factor. Severe pulmonary haemorrhage (PH) is a rare but serious potential adverse event associated with bevacizumab therapy for advanced non-squamous non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  A panel of expert oncologists, pulmonologists and radiologists reviewed the available data to identify predictive factors for PH in order to help guide physicians using bevacizumab in patients with NSCLC.
  
  
  RESULTS
  Patients with NSCLC are at an increased risk of PH owing to the underlying disease process. Patients with squamous histology and/or a history of grade ≥ 2 haemoptysis (≥ 2.5 ml per event) should not receive bevacizumab. No clinical or radiological features (including cavitation and central tumour location) reliably predict severe PH in bevacizumab-treated patients. Major blood vessel infiltration and bronchial vessel infiltration, encasement and abutting may predict PH; however, standardised radiological criteria for defining infiltration have not been established. Eligibility for bevacizumab is not affected by patient age, performance status or anticoagulation or antiplatelet therapy.
  
  
  CONCLUSIONS
  An individualised risk-benefit assessment should be undertaken in all patients with NSCLC in whom bevacizumab is being considered. Further research is required to elucidate the mechanisms underlying PH and the clinical risk factors.
authors: Department of Thoracic Oncology, Hospital Grosshansdorf, Grosshansdorf, Germany. Electronic address: dr.martin.reck@web.de.
authors: M
authors: M
authors: Reck
authors: Multidisciplinary Oncology & Therapeutic Innovations, Université de la Méditerranée Assistance Publique, Hôpitaux de Marseille, Marseille, France.
authors: F
authors: F
authors: Barlesi
authors: Department of Oncology, Hospital Santa Maria della Misericordia, Sant Andrea delle Fratte, Perugia, Italy.
authors: L
authors: L
authors: Crinò
authors: Department of Radiology, Mount Sinai School of Medicine, New York; Early Diagnosis and Treatment Research Foundation, New York, USA.
authors: C I
authors: CI
authors: Henschke
authors: Medical Oncology Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain.
authors: D
authors: D
authors: Isla
authors: Department of Thoracic Oncology, Hospital Grosshansdorf, Grosshansdorf, Germany.
authors: S
authors: S
authors: Stiebeler
authors: Sarah Cannon Research Institute, Nashville, USA.
authors: D R
authors: DR
authors: Spigel
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D000068258:Bevacizumab; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005104:Expert Testimony; D005544:Forecasting / Q000379:methods; D006470:Hemorrhage / Q000139:chemically induced / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D012307:Risk Factors
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab