title: Incidence and management of gastrointestinal perforation from bevacizumab in advanced cancers.
abstract: Bevacizumab (Avastin™, Genentech) is a monoclonal antibody that deactivates the vascular endothelial growth factor leading to disruption of vital cancer signaling pathways and inhibition of angiogenesis which results in its anti-tumor activity. The use of bevacizumab in treating cancers has steadily increased since it was initially approved by the Food and Drug Administration for metastatic colorectal cancer. Clinical trials have revealed that bevacizumab has serious side effects, including spontaneous bowel perforation, which can occur in patients who have no involvement of the gastrointestinal tract by cancer. Although risk factors for bevacizumab-associated bowel perforation have been identified, it is still unclear which patients are specifically at risk for this complication. The management of bevacizumab-induced bowel perforation depends on the clinical presentation and the goals of care set by the treating physicians and the patient.
authors.affiliation: Department of Internal Medicine, Division of Hematology, Oncology, and Bone Marrow Transplantation, The University of Iowa Hospitals and Clinics, 200 Hawkins Dr., C32 GH, Iowa City, IA 52242-1081, USA. taher-hejleh@uiowa.edu
authors.forename: Taher
authors.initials: T
authors.lastname: Abu-Hejleh
authors.forename: James J
authors.initials: JJ
authors.lastname: Mezhir
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goodheart
authors.forename: Thorvardur R
authors.initials: TR
authors.lastname: Halfdanarson
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000068258:Bevacizumab; D001943:Breast Neoplasms / Q000188:drug therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D015179:Colorectal Neoplasms / Q000188:drug therapy; D005260:Female; D005910:Glioma / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D007680:Kidney Neoplasms / Q000188:drug therapy; D008175:Lung Neoplasms / Q000188:drug therapy; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab