New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA.
Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Surg Endosc. 2021 Jun;35(6):2976-2980. doi: 10.1007/s00464-020-07738-7. Epub 2020 Jun 24.
Bevacizumab is a humanized anti-vascular endothelial growth factor monoclonal antibody used in the treatment of cervical cancer, ovarian cancer, colorectal cancer, lung cancer, renal cell cancer, and recurrent glioblastomas. Its approval by US FDA was issued with a black box warning that its use has been associated with a risk of gastrointestinal (GI) tract perforation and that it should be discontinued in patients who have experienced such. The reported incidence of GI perforation in those receiving bevacizumab is as high as 3%. However, the incidence of GI perforation in those receiving bevacizumab undergoing GI endoscopic procedures has not been well studied.
A retrospective, single-center observational study was conducted at Memorial Sloan Kettering Cancer Center (MSKCC) between 2011 and 2018. All patients who underwent upper GI endoscopy with percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ) tube placement and received bevacizumab within 6 months of their endoscopic procedure were included.
We identified 176 patients who underwent PEG or PEJ tube placement and received bevacizumab within 6 months. Eighty-one percent of patients were female (n = 144) and the median age was 61 years. Prior to endoscopic procedures, patients received a median of seven doses of bevacizumab. Patients received bevacizumab from 170 days before to 170 days after their endoscopic procedures (median 44 days). No GI perforations were observed during or after the time of the endoscopic procedures.
Our study demonstrated that receiving bevacizumab within 6 months prior to their endoscopic procedure was not associated with an increased risk of GI tract perforation and thus not an absolute contraindication to proceeding with PEG and PEJ tube placement in these patients.
贝伐珠单抗是一种人源化抗血管内皮生长因子单克隆抗体，用于治疗宫颈癌、卵巢癌、结直肠癌、肺癌、肾细胞癌和复发性胶质母细胞瘤。其被美国食品和药物管理局（FDA）批准时附有一个黑框警告，即其使用与胃肠道（GI）穿孔风险相关，应在出现此类情况的患者中停止使用。接受贝伐珠单抗治疗的患者中，GI 穿孔的报告发生率高达 3%。然而，接受贝伐珠单抗治疗并接受 GI 内镜检查的患者中 GI 穿孔的发生率尚未得到充分研究。
这是一项在纪念斯隆凯特琳癌症中心（MSKCC）于 2011 年至 2018 年期间进行的回顾性、单中心观察性研究。所有接受经皮内镜胃造口术（PEG）或经皮内镜空肠造口术（PEJ）管放置并在接受内镜检查程序前 6 个月内接受贝伐珠单抗治疗的患者均纳入研究。
我们共纳入 176 例接受 PEG 或 PEJ 管放置并在接受内镜检查程序前 6 个月内接受贝伐珠单抗治疗的患者。81%的患者为女性（n=144），中位年龄为 61 岁。在进行内镜检查程序之前，患者接受了中位 7 次贝伐珠单抗治疗。患者在接受内镜检查程序前 170 天至后 170 天内接受了贝伐珠单抗治疗（中位时间为 44 天）。在进行内镜检查程序期间或之后，未观察到任何 GI 穿孔。
我们的研究表明，在接受内镜检查程序前 6 个月内接受贝伐珠单抗治疗与 GI 道穿孔风险增加无关，因此并非这些患者进行 PEG 和 PEJ 管放置的绝对禁忌证。
