Gastrointestinal perforation

Bevacizumab 10 mg/kg IV on days 1 and 15, cycled every 28 days (paclitaxel 90 mg/m2 IV on days 1, 8 and 15) Hypertension, gastrointestinal perforation, impaired wound healing, bleeding, thromboembolic events, proteinuria... 

Serious, sometimes fatal, side effects reported included gastrointestinal perforation, wound healing complications and haemorrhage, and the product should not be administered for at least 28 days following major surgery. Avastin was developed by Genentech. 

Coverage against obligate anaerobic bacilli should be provided for distal small-bowel and colon-derived infections and for more-proximal gastrointestinal perforations when obstruction is present. 

Gastrointestinal perforation occurred in 1.5% of patients on the three-drug regimen... 

A study of the risk factors for gastrointestinal perforation, a much less frequent event than bleeding, has confirmed that aspirin and other NSAIDs increase the risk of both upper and lower gastrointestinal perforation (OR 6.7, Cl 3.1-14.5 for NSAIDs) (53). Gastrointestinal perforation has been associated with other factors, such as coffee consumption, a history of peptic ulcer, and smoking. The combination of NSAIDs, smoking, and alcohol increased the risk of gastrointestinal perforation (OR 10.7, Cl 3.8-30) (SEDA-21, 97). 

Lanas A, Serrano P, Bajador E, Esteva F, Benito R, Sainz R. Evidence of aspirin use in both upper and lower gastrointestinal perforation. Gastroenterology 1997 112(3) 683-9. 

In a retrospective analysis over 13 years of cytostatic therapy for various conditions there were 12 cases in which chemotherapy had caused gastrointestinal perforation (43). Six doses of etoposide each of 250 mg/m induced an advanced stage (grade 4) of mucositis. Fifty percent of patients receiving epirubicin 120 mg/m ... 

Cornea perforation Gastrointestinal bleeding [5] Gastrointestinal perforation [5] Gastrointestinal strictures [5]... 

Bevacizumab Inhibition of angiogenesis/ neovascularization 5 mg/kg IV every 14 days until disease progression Hypertension pulmonary hemorrhage gastrointestinal perforation proteinuria congestive heart failure... 

The risk of serious upper gastrointestinal bleeding was inereased by the use of more than one NSAID in a meta-analysis of data from three ease-eontrolled studies (odds ratio 4.9 with one NSAID and 10.7 with two). Another study provided similar findings the odds ratio was 7.1 with one NSAID and 12.3 with two or more NSAIDs. Similar findings have been reported with aspirin and NSAIDs, see NSAIDs + Aspirin Anti-inflammatory dose , p.l42. Analysis of yellow eard reports to the CSM in the UK, of gastrointestinal perforation, obstruetion, uleeration or bleeding with diclofenac, naproxen, and ibuprofen, revealed that 6% of the patients were reeeiving another non-aspirin NSAID. ... 

Observational studies In a prospective study of bevacizumab combined with chemotherapy for first-line treatment of metastatic colorectal cancer, bevacizumab-related adverse events were gastrointestinal perforation (1.9%), arterial thromboembolic events (2%), grade 3—4 bleeding (2.2%), and de novo hypertension requiring medication (22%) [81 =]. 

Bevacizumab plus first-line chemotherapy has been evaluated in the Bevacizumab Expanded Access Trial (BEAT) in patients with unresectable metastatic colorectal cancer [82 ]. The serious/grade 3-5 adverse events with bevacizumab included hypertension (5.3%), bleeding (3%), gastrointestinal perforation (2%), arterial thromboembolism (1%), proteinuria (1%), and wound-healing complications (1%). 

Gastrointestinal Gastrointestinal perforation is a well-known adverse reaction to bevacizumab and in one series occurred in six of 160 patients with recurrent ovarian carcinoma three died by 30 days and only two survived beyond 65 days [99 ]. 

Diaz JP, Tew WP, Zivanovic O, Konner J, Sabbatini PJ, dos Santos LA, Abu-Rustum NR, Chi DS, Aghajanian C, Barakat RR. Incidence and management of bevacizumab-associated gastrointestinal perforations in patients with recurrent ovarian carcinoma. Gynecol Oncol 2010 116(3) 335-9. 

Apart from clinical or radiological signs of gastrointestinal perforation there are no contraindications to stent placement as long as the guidewire can be safely passed across the obstruction. 

Gastrointestinal Gastrointestinal perforation, in some cases fatal, has been observed in patients receiving rituximab for malignant disease in most of these cases, rituximab was administered with chemotherapy [295 298 ]. 

Sfakianos GP, Numnum TM, Halverson CB, Panjeti D, Kendrick IV JE, Straughn Jr. JM. The risk of gastrointestinal perforation and/or fistula in patients with recurrent ovarian cancer receiving bevacizumab compared to standard chemotherapy a retrospective cohort study. Gynecol Oncol 2009 114 (3) 424-6. 

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