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Medline ® Abstract for Reference 86

of 'Toxicity of molecularly targeted antiangiogenic agents: Non-cardiovascular effects'

Bowel perforation in non-small cell lung cancer after bevacizumab therapy.
Schellhaas E, Loddenkemper C, Schmittel A, Buhr HJ, Pohlen U
Invest New Drugs. 2009 Apr;27(2):184-7. Epub 2008 Jul 30.
BACKGROUND: Bevacizumab is increasingly used in combination with chemotherapy for treatment of unresectable non-small cell lung cancer. The aim of this report is to underline possible risks associated with this otherwise well-tolerated drug.
PATIENT: A 69-year-old patient with metastatic non-small cell lung cancer was started on a palliative chemotherapy regimen containing carboplatin, paclitaxel, and bevacizumab.
RESULTS: After the second cycle of chemotherapy, the patient developed abdominal pain. On emergency laparotomy, there was diffuse perforation of the colonic wall, so the patient underwent a Hartmann's procedure with subtotal colectomy. Histopathological examination confirmed the diagnosis of ischemic colitis.
CONCLUSION: Gastrointestinal perforation is a known adverse event of bevacizumab therapy which so far has occurred only in patients with predisposing risk factors. Our patient illustrates that there must always remain a high index of suspicion regarding bowel perforation in patients developing acute abdominal pain under bevacizumab therapy, even if they have no apparent risk factors.
Chirurgische Klinik I, CharitéCampus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. elisabeth.schellhaas@charite.de