Bevacizumab in the treatment of a patient with metastatic colorectal carcinoma with brain metastases.

The development of brain metastases originating from colorectal cancer (CRC) is an infrequent phenomenon occurring in < 5% of patients. Yet, it is feasible that physicians will be diagnosing more patients with brain metastases because of the prolonged survival in our current patient population. The anti-angiogenic agent bevacizumab is currently approved in bevacizumab-naive patients with metastatic CRC (mCRC). Initially, precautionary measures regarding the use of bevacizumab were recommended for patients at risk of bleeding based on earlier incidents of intracranial hemorrhage, hemoptysis, and pulmonary hemorrhage. However, recent data support the use of bevacizumab in the treatment of high-grade gliomas. We present a challenging case of a treatment-naive patient with mCRC with brain metastases and the challenges involved in weighing the risks and benefits of systemic chemotherapy when combined with a biologic agent.