Review: Incidence and clinical significance of Bevacizumab-related non-surgical and surgical serious adverse events in metastatic colorectal cancer

Objective and backgroundThis review describes the extent, frequency and clinical importance of Bevacizumab(BV)-related serious adverse events (SAE) after surgery, during or after chemotherapy with BV in patients with metastatic colorectal cancer (mCRC).MethodsDetailed PubMed search in November 2009.ResultsAddition of BV to first- or second-line chemotherapy in patients with mCRC results in a statistically significant benefit in OS, PFS and RR.Addition of BV to chemotherapy causes no clinically relevant aggravation of SAE and seems safe with the primary tumor still in situ. The risk of emergency surgery due to BV-related SAE is estimated 2.0%.SAE rate is low if a time to surgery of 5–6 weeks is respected. The majority of SAE are wound healing complications. Bleeding and GI perforation occur infrequently, even following major surgery after BV-treatment. Major surgery during the course of BV-treatment results in an SAE rate of 1.3–2.7%. Postoperatively, a period of minimally 28 days should be respected before starting BV.ConclusionReported rates of BV-related SAE in relationship to surgery are low.