title: Cervical extravasation of bevacizumab.
abstract: Monoclonal antibodies such as bevacizumab are widely used in medical oncology, either alone or in combination with chemotherapy. No specific recommendations on the management of monoclonal antibodies extravasation exist. Incidence rates vary considerably. Estimates of 0.5-6% have been reported in the literature. Also, patient-associated and procedure-associated risk factors of extravasation are multiple, such as bolus injections or poorly implanted central venous access. We report on an 86-year-old woman with colon cancer with liver metastasis who was treated with 5-fluorouracil, folinic acid, and bevacizumab. Extravasation occurred during chemotherapy infusion because of a catheter migration of the port outside of the superior vena cava, causing cervical pain without skin modifications. Diagnosis was confirmed with the appearance of clinical right cervical tumefaction and cervicothoracic computed tomography scan indicated a perijugular hypodense collection, corresponding to the extravasation. Conservative management was proposed. The patient recovered within 3 weeks from all symptoms. Physicians should be aware that in cases of bevacizumab extravasation, a nonsurgical approach might be effective.
authors.affiliation: Departments of Gastroenterology, Cochin Teaching Hospital, AP-HP, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
authors.forename: Johann
authors.initials: J
authors.lastname: Dréanic
authors.forename: Romain
authors.initials: R
authors.lastname: Coriat
authors.forename: Olivier
authors.initials: O
authors.lastname: Mir
authors.forename: Géraldine
authors.initials: G
authors.lastname: Perkins
authors.forename: Pascaline
authors.initials: P
authors.lastname: Boudou-Rouquette
authors.forename: Catherine
authors.initials: C
authors.lastname: Brezault
authors.forename: Marion
authors.initials: M
authors.lastname: Dhooge
authors.forename: François
authors.initials: F
authors.lastname: Goldwasser
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D000068258:Bevacizumab; D062905:Central Venous Catheters / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000188:drug therapy; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D019547:Neck Pain / Q000139:chemically induced*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011859:Radiography; D013350:Subclavian Vein; D062666:Vascular Access Devices; D014683:Vena Cava, Superior / Q000293:injuries*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil