Intestinal perforation in colorectal cancers treated with bevacizumab (Avastin)

Abstract

Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), and it has shown promise as a clinical agent against metastatic colorectal cancer, and particularly in combination with chemotherapy. Bowel perforation is a known risk that's associated with bevacizumab use, but the etiology is unknown. Here we report on two cases of metastatic colorectal cancer in which the patients suffered from intestinal perforation after chemotherapy with bevacizumab. For the first case, a 47 year-old man had rectal cancer with concurrent liver and lung metastasis. He underwent chemotherapy with 5-fluorouracil, irinotecan and bevacizumab. Fever and abdominal pain developed seven days later, and rectal perforation was identified upon exploration 13 days later. For the second case, a 48 year-old woman had sigmoid colon cancer with peritoneal and ovary metastases. After seven days of chemotherapy with 5-fluorouracil, oxaliplatin and bevacizumab, exploratory surgery revealed a perforation at the ileum.

Keywords: Bevacizumab; Colorectal neoplasms; Intestinal perforation.

Fig. 1

Operation findings. Rectal perforation was identified at the sacral promontory level, which was the primary tumor site in case 1.

Fig. 2

Operation findings. An ileal perforation was identified in case 2. The proximal intestine was moderate distended and it showed wall thickening.