Complications of palliative antiangiogenic therapy in patients with colorectal cancer

• Authors: Małgorzata Domagała-Haduch , Marek Jasiówka , Łukasz Nowak , Ida Cedrych
• Languages of publication: EN

Abstracts

EN

Introduction: Bevacizumab is an antiangiogenic drug used in the therapy of numerous solid tumours including colorectal adenocarcinoma. The efficacy and safety of bevacizumab has been demonstrated in many multicenter clinical trials. The scope of this paper is to analyze the safety profile of bevacizumab in patients with stage IV colorectal cancer. Aim of the study: Analysis of toxicity and safety of the treatment with bevacizumab patients with colorectal cancer in the metastatic stage. Material and methods: Retrospective analysis of medical records of 42 patients with advanced colorectal cancer treated in the Department of Systemic and Generalized Malignancies, Maria Skłodowska-Curie Memorial Institute of Oncology, Kraków Branch, in the period 2007–2014. Results: The median time of treatment with bevacizumab was 6 months. The median duration of progression-free survival (PFS) was 8.5 months. Toxicity of treatment with bevacizumab affected 43 percent of patients. The most common adverse events observed was hypertension and bleeding. In 6 patients (14.3%) the treatment with bevacizumab was interrupted due to adverse events (thromboembolic events, bleeding and gastrointestinal perforation). Conclusions: Bevacizumab is a safe therapeutic option in patients with metastatic colorectal cancer, provided that patients are provided close oncological and general medical monitoring.

Keywords

EN

adverse effects; bevacizumab; colorectal cancer; treatment safety

Discipline

• MEDICINE: MEDICINE

• Journal: OncoReview
• Year: 2016
• Volume: 6
• Issue: 4
• Pages: A199-204

Contributors

author

Małgorzata Domagała-Haduch

• Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Institute of Oncology, Krakow Branch, Poland,

author

Marek Jasiówka

• Department of Gynecologic Oncology, Center of Oncology, Maria Sklodowska-Curie Memorial Institute of Oncology, Krakow Branch, Poland

author

Łukasz Nowak

• Department of Anaesthesiology and Intensive Care, Maria Sklodowska-Curie Memorial Institute of Oncology, Krakow Branch, Poland

author

Ida Cedrych

• Department of Systemic and Generalized Malignancies, Maria Sklodowska-Curie Memorial Institute of Oncology, Krakow Branch, Poland

References

• 1. Gimbrone Jr MA, Leapman SB, Cotran RS, Folkman J. Tumor dormancy in vivo by prevention of neovascularization. J Exp Med 1972; 136: 261-276.
• 2. Ferrara N. Vascular endothelial growth factor: molecular and biological aspects. Curr Top Microbiol Immunol 1999; 237: 1-30.
• 3. Ferrara N. VEGF-A: a critical regulator of blood vessel growth. Eur Cytokine Netw 2009; 20: 158-163.
• 4. Alitalo K, Tammela T, Petrova TV. Lymphangiogenesis in development and human disease. Nature 2005; 438: 946-953.
• 5. Berse B, Brown LF, Van de Water L et al. Vascular permeability factor (vascular endothelial growth factor) gene is expressed differentially in normal tissues, macrophages, and tumors. MolBiol Cell 1992; 3: 211-220.
• 6. Takahashi Y, Kitadai Y, Bucana CD et al. Expression of vascular endothelial growth factor and its receptor, KDR, correlates with vascularity, metastasis, and proliferation of human colon cancer. Cancer Res 1995; 55: 3964-3968.
• 7. Ellis LM, Takahashi Y, Liu W, Shaheen RM. Vascular endothelial growth factor in human colon cancer: biology and therapeutic implications Oncologist 2000; 5(Suppl 1): 11-15.
• 8. Ferrara N. Bevacizumab (Avastin), a humanized anti-VEGF monoclonal antibody for cancer therapy. Biochem Biophys Res Commun 2005; 333: 328-335.
• 9. Hurwitz H, Fehrenbacher L, Novotny V et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004; 350: 2335-2342.
• 10. Giantonio BJ, Catalano PJ, Meropol NJ et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 2007; 25: 1539-1544.
• 11. Wagner AD, Arnold D, Grothey AA et al. Anti-angiogenic therapies for metastatic colorectal cancer. Cochrane Database Syst Rev 2009; 3: CD005392.
• 12. Qi WX, Fu S, Zhang Q, Guo XM. Bevacizumab increases the risk of infections in cancer patients: A systematic review and pooled analysis of 41 randomized controlled trials. Crit Rev Oncol Hematol 2015; 94: 323-336.
• 13. Ranpura V, Hapani S, Wu S. Treatment-related mortality with bevacizumab in cancer patients: a meta-analysis. JAMA 2011; 305: 487-494.
• 14. Ahmadizar F, Onland-Moret NC, de Boer A et al. Efficacy and safety assessment of the addition of bevacizumab to adjuvant therapy agents in cancer patients: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2015; 10: e0136324.
• 15. Majid N, Ghissassi I, Mrabti H, Errihani H. Bevacizumab in clinical practice. Gulf J Oncolog 2015; 1: 33-37.
• 16. Pavlidis ET, Pavlidis TE. Role of bevacizumab in colorectal cancer growth and its adverse effects: a review. World J Gastroenterol 2013; 19: 5051-5060.
• 17. Hurwitz H, Saini S. Bevacizumab in the treatment of metastatic colorectal cancer: safety profile and management of adverse events. Semin Oncol 2006; 33(5 Suppl 10): S26-34.
• 18. Saltz LB, Clarke S, Diaz-Rubio E et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008; 26: 2013-2019.
• 19. Nalluri SR, Chu D., Keresztes R et al. Risk of venous thromboembolism with the angiogenesis inhibitor bevacizumab in cancer patients: a meta- analysis. JAMA 2008; 300(19): 2277-2285.
• 20. Scappaticci FA, Skillings JR, Holden SN et al. Arterial thromboembolic events in patients with metastatic carcinoma treated with chemotherapy and bevacizumab. J Natl Cancer Inst 2007; 99: 1232-1239.
• 21. Schutz FA, Je Y, Azzi GR et al. Bevacizumab increases the risk of arterial ischemia: a large study in cancer patients with a focus on different subgroup outcomes. Ann Oncol 2011; 22: 1404-1412.
• 22. Kozloff M, Yood MU, Berlin J et al. Clinical outcomes associated with bevacizumab-containing treatment of metastatic colorectal cancer: the BRiTE observational cohort study. Oncologist 2009; 14: 862-870.
• 23. Van Cutsem E, Rivera F, Berry S et al. Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol 2009; 20: 1842-1847.
• 24. Nazer B, Humphreys BD, Moslehi J. Effects of novel angiogenesis inhibitors for the treatment of cancer on the cardiovascular system: focus on hypertension. Circulation 2011; 124: 1687-1691.
• 25. Economopoulou P, Kotsakis A, Kapiris I, Kentepozidis N. Cancer therapy and cardiovascular risk: focus on bevacizumab. Cancer Manag Res 2015; 7: 133-143.
• 26. Cai J, Ma H, Huang F et al. Correlation of bevacizumab-induced hypertension and outcomes of metastatic colorectal cancer patients treated with bevacizumab: a systematic review and meta-analysis. World J Surg Oncol 2013; 11: 306.
• 27. Feliu J, Salud A, Safont MJ et al. Correlation of hypertension and proteinuria with outcome in elderly bevacizumab-treated patients with metastatic colorectal cancer. PLoS One. 2015; 10(1): e0116527.
• 28. Curigliano G, Cardinale D, Suter T et al. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Ann Oncol 2012; (23 suppl 7): 155-166.
• 29. Lafayette RA, McCall B, Li N et al. Incidence and relevance of proteinuria in bevacizumab-treated patients: pooled analysis from randomized controlled trials. Am J Nephrol 2014; 40: 75-83.

• Document Type: article