Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Gynecol Oncol. 2010 Mar;116(3):335-9. doi: 10.1016/j.ygyno.2009.11.017. Epub 2009 Dec 11.
The objective of this study was to examine the incidence and management of bevacizumab-associated gastrointestinal (GI) perforations in patients with recurrent ovarian carcinoma.
We identified all patients who received bevacizumab off protocol from August 2004-August 2008. We examined their medical records for reports of confirmed GI perforation, associated clinicopathological factors, treatment, and outcomes.
Six (4%) of 160 patients with ovarian carcinoma who had been treated with bevacizumab developed GI perforations, with a median of 4 (range, 2-8) previous cytotoxic regimens. The median serum CA-125 at the start of treatment was 228 U/mL (range, 50-3106 U/mL). The median number of bevacizumab cycles prior to perforation was 10.5 (range, 2-20). The median time from the last bevacizumab dose to diagnosis of GI perforation was 13 days (range, 1-28 days). Four (67%) patients underwent an exploratory surgery. At laparotomy, one had a gastric perforation and one had an appendiceal perforation; the site of perforation could not be identified in the other 2 Two patients (33%) were managed conservatively-one with a PEG tube and the other with supportive care. The median time of death from the date of diagnosis of GI perforation was 27 days (range, 4-326 days). Only two patients-one with a gastric and the other with an appendiceal perforation-survived >65 days. The 30-day mortality rate following a bevacizumab-associated GI perforation was 50%.
Bevacizumab-associated GI perforations in patients with recurrent ovarian carcinoma occurred in 4% of our patients. The prognosis of patients diagnosed with bevacizumab-associated GI perforations in this study was poor, and treatment should be individualized.
本研究旨在探讨复发性卵巢癌患者贝伐珠单抗相关胃肠道（GI）穿孔的发生率和处理方法。
我们确定了所有在 2004 年 8 月至 2008 年 8 月期间接受贝伐珠单抗方案外治疗的患者。我们检查了他们的病历，以确定是否有确诊的 GI 穿孔报告，以及相关的临床病理因素、治疗和结局。
在接受贝伐珠单抗治疗的 160 例卵巢癌患者中，有 6 例（4%）发生了 GI 穿孔，其中中位数为 4 次（范围，2-8 次）先前的细胞毒性方案。治疗开始时的中位血清 CA-125 为 228 U/mL（范围，50-3106 U/mL）。穿孔前接受贝伐珠单抗的中位数周期数为 10.5（范围，2-20）。从最后一次贝伐珠单抗剂量到诊断为 GI 穿孔的中位数时间为 13 天（范围，1-28 天）。4 例（67%）患者接受了探查性手术。剖腹探查时，1 例发生胃穿孔，1 例发生阑尾穿孔；另 2 例患者穿孔部位无法确定。2 例患者（33%）接受了保守治疗-1 例采用 PEG 管，另 1 例采用支持性治疗。从 GI 穿孔诊断日期到死亡的中位数时间为 27 天（范围，4-326 天）。仅 2 例患者（1 例胃穿孔，1 例阑尾穿孔）存活时间超过 65 天。贝伐珠单抗相关 GI 穿孔后 30 天的死亡率为 50%。
在复发性卵巢癌患者中，贝伐珠单抗相关的 GI 穿孔发生率为 4%。本研究中诊断为贝伐珠单抗相关 GI 穿孔的患者预后较差，治疗应个体化。
