Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Sep;43(9):2844-2858.
doi: 10.1002/hed.26772. Epub 2021 Jun 12.

Bleeding complications in patients with squamous cell carcinoma of the head and neck

Cristiana Bergamini  1 , Robert L Ferris  2 , Jing Xie  3 , Gabriella Mariani  4 , Muzammil Ali  5 , William C Holmes  5 , Kevin Harrington  6 , Amanda Psyrri  7 , Stefano Cavalieri  1 , Lisa Licitra  1   8
Affiliations
Review

Bleeding complications in patients with squamous cell carcinoma of the head and neck

Cristiana Bergamini et al. Head Neck. 2021 Sep.

Abstract

Hemorrhage in recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) may be attributed to chemotherapy and local tumor irradiation. Evidence of the relationship between hemorrhage in R/M HNSCC and targeted therapies, including epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) inhibitors, or immune checkpoint inhibitors, is limited. We aimed to identify epidemiological and clinical data related to the occurrence of hemorrhage in R/M HNSCC and to explore its relationship with various therapies. We describe information obtained from literature searches as well as data extracted from a commercial database and a database from the author's institution (Istituto Nazionale dei Tumori of Milan). Evidence suggests that most bleeding events in R/M HNSCC are minor. Clinical trial safety data do not identify a causal association between hemorrhage and anti-EGFR agents or immune checkpoint inhibitors. In contrast, anti-VEGF agents are associated with increased, and often severe/fatal, hemorrhagic complications.

Keywords: antiangiogenic drugs; head and neck squamous cell carcinoma; hemorrhage; immune checkpoint inhibitors; molecular targeted therapies.

PubMed Disclaimer

Conflict of interest statement

Robert L. Ferris. Consulting or Advisory Role: Aduro Biotech Inc., Bristol Myers Squibb, Merck, Pfizer, EMD Serono, Numab Therapeutics AG, Macrogenics, Novasenta (Stock as well). Research Funding: Bristol Myers Squibb, AstraZeneca/MedImmune, Merck, Tesaro, Novasenta. Jing Xie, Gabriella Mariani, and Muzammil Ali are employed by AstraZeneca. William C. Holmes was employed by AstraZeneca and he is currently employed by GlaxoSmithKline. Kevin Harrington: Consulting or Advisory Role: Arch Oncology, AstraZeneca/Medimmune, Bristol Myers Squibb, Boehringer‐Ingelheim, Merck‐Serono, Merck‐Sharp‐Dohme, Nanobiotix, Oncolys, Pfizer, Replimune, Vyriad. Research Funding: AstraZeneca/MedImmune, Boehringer‐Ingelheim, Merck‐Sharp‐Dohme, Replimune, The Royal Marsden Hospital/The Institute of Cancer Research National Institute for Health Research Biomedical Research Centre. Amanda Psyrri: Honoraria: Merck Serono, Roche, BMS, MSD Oncology, Genesis Pharmaceuticals, Bayer, Rakuten, AstraZeneca, Pfizer. Consulting or Advisory Role: AstraZeneca, MSD Oncology, Pfizer, Bristol‐Myers Squibb, Amgen, Rakuten. Research Funding: Kura, Bristol‐Myers Squibb, Roche, Amgen, Boehringer Ingelheim, Pfizer, Demo Pharmaceutical, Pharmaten. Travel, Accommodations, Expenses: Roche, MSD Oncology, Ipsen, Bristol‐Myers Squibb, Ipsen. Uncompensated relationships: AstraZeneca, AstraZeneca. Lisa Licitra: Grants/research supports (funds received by my institution for clinical studies and research activities in which I am involved): Astrazeneca, BMS, Boehringer Ingelheim, Celgene International, Debiopharm International SA, Eisai, Exelixis Inc., Hoffmann‐La Roche Ltd., IRX Therapeutics Inc., Medpace Inc., Merck‐Serono, MSD, Novartis, Pfizer, Roche. Honoraria or consultation fees (for public speaking/teaching in medical meetings and/or for expert opinion in advisory boards): Astrazeneca, Bayer, BMS, Eisai, MSD, Merck‐Serono, Boehringer Ingelheim, Novartis, Roche, Debiopharm International SA, Sobi, Ipsen, Incyte Biosciences Italy srl, Doxa Pharma, Amgen,Nanobiotics Sa and GSK. Public speaking/teaching from research companies & commercial education providers: AccMed, Medical Science Fundation G. Lorenzini, Associazione Sinapsi, Think 2 IT, Aiom Servizi, Prime Oncology, WMA Congress Education, Fasi, DueCi promotion Srl, MI&T, Net Congress & Education, PRMA Consulting, Kura Oncology, Health & Life srl, Immuno‐Oncology Hub. Cristiana Bergamini and Stefano Cavalieri have no conflict of interest to disclose.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Cohen EEW, Bell RB, Bifulco CB, et al. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC). J Immunother Cancer. 2019;7(1):184. - PMC - PubMed
    1. Pereira J, Phan T. Management of bleeding in patients with advanced cancer. Oncologist. 2004;9(5):561‐570. - PubMed
    1. Johnstone C, Rich SE. Bleeding in cancer patients and its treatment: a review. Ann Palliat Med. 2018;7(2):265‐273. - PubMed
    1. Soria JC, Deutsch E. Hemorrhage caused by antiangiogenic therapy within previously irradiated areas: expected consequence of tumor shrinkage or a warning for antiangiogenic agents combined to radiotherapy? Ann Oncol. 2011;22(6):1247‐1249. - PubMed
    1. Weycker D, Hatfield M, Grossman A, et al. Risk and consequences of chemotherapy‐induced thrombocytopenia in US clinical practice. BMC Cancer. 2019;19(1):151. - PMC - PubMed

Publication types

MeSH terms

Substances