title: An observational study of nasal cavity toxicity in cancer patients treated with bevacizumab.
abstract: BACKGROUND
  The nasal cavity is a vulnerable zone which may be damaged by vascular disorders. We systematically assessed the frequency and severity of nasal cavity alterations during bevacizumab treatment, to determine its clinical relevance and factors contributing to its onset.
  
  
  METHODS
  We conducted a hospital-based cohort study in 47 consecutive patients with advanced cancers who were on treatment with chemotherapy and bevacizumab at different doses. All patients underwent otolaryngology (ENT) examination at the time of study initiation.
  
  
  RESULTS
  The mean number of cycles at first ENT examination was 16 (standard deviation = 14). A total of 45 patients (96%) showed nose mucosal lesions, of whom 30% had erosions and 62% had grade 1 - 2 epistaxis. One patient had septal perforation. Grades 1 - 4 sinus disorders were noted in 60%. There was a significant trend to a higher risk of grade ≥ 2 nasal events for bevacizumab doses > 7.5 mg/kg, concomitant taxane use and digital nasal self-manipulation.
  
  
  CONCLUSIONS
  We found a high incidence of nasal cavity lesions in patients receiving bevacizumab, with evidence for a dose-related effect. Most cases were low grade and manageable without drug interruption, but severe toxicity may rarely occur. Oncologists should be aware of this unusual event.
authors.affiliation: E.O. Ospedali Galliera, Unit of Medical Oncology , Mura delle Cappuccine 14, 16128 Genova , Italy +39 0105634501 ; +39 01057481090 ; andrea.decensi@galliera.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: D'Amico
authors.forename: Mauro
authors.initials: M
authors.lastname: Pagano
authors.forename: Ambra
authors.initials: A
authors.lastname: Pasa
authors.forename: Matteo
authors.initials: M
authors.lastname: Puntoni
authors.forename: Matteo
authors.initials: M
authors.lastname: Clavarezza
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gennari
authors.forename: Alberto
authors.initials: A
authors.lastname: Gozza
authors.forename: Silvia
authors.initials: S
authors.lastname: Zanardi
authors.forename: Carlotta
authors.initials: C
authors.lastname: Defferrari
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Provinciali
authors.forename: Eleonora
authors.initials: E
authors.lastname: Campazzi
authors.forename: Sara
authors.initials: S
authors.lastname: Campora
authors.forename: Laura
authors.initials: L
authors.lastname: Paleari
authors.forename: Domenico
authors.initials: D
authors.lastname: Marra
authors.forename: Marilena
authors.initials: M
authors.lastname: Petrera
authors.forename: Andrea
authors.initials: A
authors.lastname: DeCensi
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000068258:Bevacizumab; D004305:Dose-Response Relationship, Drug; D004844:Epistaxis / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000187:drug effects* / Q000473:pathology; D009297:Nasal Mucosa / Q000187:drug effects* / Q000473:pathology; D061270:Nasal Septal Perforation / Q000139:chemically induced* / Q000175:diagnosis; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
keywords: adverse drug event; bevacizumab; epistaxis; nasal septum