title: Neoadjuvant bevacizumab: surgical complications of mastectomy with and without reconstruction.
abstract: Neoadjuvant therapy (NAC) is commonly used in operable breast cancer. Previous studies have suggested a high rate of postoperative complications after NAC. We prospectively evaluated the surgical complications in a cohort of patients who underwent mastectomy following neoadjuvant adriamycin/cytoxan/taxol (AC/T) plus bevacizumab (bev) and compared the rate of complications to a matched cohort of neoadjuvant AC/T without bev. One hundred patients with HER2-negative breast cancer enrolled in a single-arm trial of neoadjuvant AC/T plus bev (cohort 1), 60 of these patients underwent mastectomy and were matched with 59 patients who received standard neoadjuvant AC/T (cohort 2) over a similar time period in the same healthcare system. All patients underwent mastectomy with or without reconstruction. Fisher's exact tests were used to compare complication rates, with p < 0.05 considered significant. Patients were matched well in terms of demographics. The overall complication rate was 32 % in cohort 1 and 31 % in cohort 2 (p value = 1, Table 1). In cohort 1, 7 of 23 (30 %) patients who underwent immediate expander/implant reconstruction had complications, including 2 patients who had explantation of their reconstructions. In cohort 2, 0 of 8 (0 %) had complications (p value = 0.15). Nearly a third of patients undergoing NAC with AC/T with or without bev developed a postoperative complication after mastectomy. The use of bev was not associated with a significant increase in surgical complications, although this is a nonrandomized data set with a small sample size. As larger data sets become available with the use of neoadjuvant bevacizumab with mastectomy, further refinement may be necessary.
authors.affiliation: Brigham and Women's Hopspital, Boston, MA, USA, karikansal@gmail.com.
authors.forename: Kari Joanne
authors.initials: KJ
authors.lastname: Kansal
authors.forename: Laura Stewart
authors.initials: LS
authors.lastname: Dominici
authors.forename: Sara M
authors.initials: SM
authors.lastname: Tolaney
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Isakoff
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.forename: Jane E
authors.initials: JE
authors.lastname: Brock
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Ian E
authors.initials: IE
authors.lastname: Krop
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab