title: Nasal septal perforation secondary to systemic bevacizumab.
abstract: OBJECTIVE
  A case of nasal septal perforation secondary to systemic bevacizumab therapy for ovarian cancer is reported. Bevacizumab is a vascular endothelial growth factor A (VEGF-A) inhibitor that is becoming more widely utilized in the oncologic community. There is only one prior report of septal perforation secondary to bevacizumab in the Otolaryngology specific literature. The purpose of this report is: 1) to raise awareness and discuss the literature surrounding the sinonasal complications of bevacizumab and 2) provide workup and treatment recommendations based on the sum of the available literature.
  
  
  METHODS
  We review the clinical record of a 59year old patient who presented with an anterior septal perforation while taking bevacizumab therapy for ovarian cancer. She had mild symptoms. Her oncologist held bevacizumab and topical moisture therapy was started. After several weeks, the perforation remained stable and bevacizumab was restarted for her ovarian cancer.
  
  
  CONCLUSIONS
  Bevacizumab is associated with both septal perforation and more widespread sinonasal toxicity. These lesions tend to produce only mild symptoms and can usually be managed conservatively. The decision to hold bevacizumab therapy should be made in conjunction with the patient and medical oncologist. Otolaryngologists should be aware of the toxicity from this increasingly common oncologic therapy.
authors.affiliation: Department of Otolaryngology- Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA; University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. Electronic address: geltzeilermn@upmc.edu.
authors.forename: Mathew
authors.initials: M
authors.lastname: Geltzeiler
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA.
authors.forename: Toby O
authors.initials: TO
authors.lastname: Steele
mesh_terms: D000281:Administration, Intranasal; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000068258:Bevacizumab / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005782:Gels / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D061270:Nasal Septal Perforation / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D009300:Nasal Septum / Q000000981:diagnostic imaging*; D010051:Ovarian Neoplasms / Q000188:drug therapy; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D005782:Gels; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: Avastin; Bevacizumab; Chemotherapy; Hereditary hemorrhagic telangiectasia; Nasal septum; Ovarian cancer; Perforation; Septal perforation; Sinonasal pathology