PMID- 28472195
OWN - NLM
STAT- MEDLINE
DCOM- 20170915
LR  - 20181202
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 5
DP  - 2017
TI  - Safety of endoscopy in cancer patients on antiangiogenic agents: A retrospective 
      multicenter outcomes study.
PG  - e0176899
LID - 10.1371/journal.pone.0176899 [doi]
LID - e0176899
AB  - BACKGROUND/AIMS: The use of antiangiogenic agents (AAs) in cancer treatment has 
      increased because they offer survival benefit in combination with cytotoxic 
      chemotherapy. Given their potential to cause gastrointestinal (GI) perforation 
      and bleeding, it is currently recommended that AAs be held for 28 days before and 
      after surgery. However, there are no specific guidelines which address their use 
      around endoscopic procedures because data regarding the safety of endoscopy in 
      cancer patients while on AAs is scarce despite the fact that these patients often 
      require endoscopy. This study investigated the safety of endoscopy in cancer 
      patients receiving AAs. METHODS: This is a retrospective multicenter study of a 
      consecutive case series of 445 cancer patients undergoing endoscopy within 31 
      days of administration of AAs at 5 specialized cancer centers between April 2008 
      and August 2014. Endoscopies were classified into two different categories based 
      on the risk of GI bleeding and perforation: low and high. The primary outcome 
      measures were procedure-related adverse events (AEs) and death within 30 days of 
      endoscopy. The severity of AEs was classified according to the common terminology 
      criteria for adverse events (CTCAE) version 4.0. The incidence of AEs and 
      mortality was calculated using the total number of patients as the denominator. 
      RESULTS: 445 cancer patients with a mean age of 54 years underwent a total of 545 
      endoscopies. Median time duration from AAs to endoscopy was 11 days. Of 545 
      endoscopic procedures, 398 (73%) were low-risk and 147 (27%) were high-risk. 
      There were 3 procedure-related AEs: esophageal perforation (grade 3) two days 
      after an EGD, pancreatitis (grade 5) a day after failed ERCP, and bleeding from 
      the gastrostomy site (grade 1) two days after an EGD. Of 445 patients, 29 (6.5%) 
      died within 30 days of the procedure with no deaths deemed procedure-related. The 
      most common causes of death were terminal cancer (n = 10), hepatic decompensation 
      (n = 5) and sepsis (n = 4). CONCLUSION: In this retrospective study, the rate of 
      endoscopy-related AEs in patients on AAs appears to be low when performed in 
      specialized cancer centers. However, future prospective studies are needed to 
      confirm this finding.
FAU - Kachaamy, Toufic
AU  - Kachaamy T
AD  - Cancer Treatment Centers of America, 5900 Broken Sound Parkway, Boca Raton, 
      Florida, United States of America.
FAU - Gupta, Digant
AU  - Gupta D
AD  - Cancer Treatment Centers of America, 5900 Broken Sound Parkway, Boca Raton, 
      Florida, United States of America.
FAU - Edwin, Persis
AU  - Edwin P
AD  - Cancer Treatment Centers of America, 5900 Broken Sound Parkway, Boca Raton, 
      Florida, United States of America.
FAU - Vashi, Pankaj
AU  - Vashi P
AD  - Cancer Treatment Centers of America, 5900 Broken Sound Parkway, Boca Raton, 
      Florida, United States of America.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20170504
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Angiogenesis Inhibitors)
RN  - 0 (Recombinant Fusion Proteins)
RN  - 15C2VL427D (aflibercept)
RN  - 2S9ZZM9Q9V (Bevacizumab)
RN  - EC 2.7.10.1 (Receptors, Vascular Endothelial Growth Factor)
SB  - IM
MH  - Angiogenesis Inhibitors/adverse effects/*therapeutic use
MH  - Bevacizumab/adverse effects/therapeutic use
MH  - Endoscopy/adverse effects/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Male
MH  - Neoplasms/*drug therapy
MH  - Receptors, Vascular Endothelial Growth Factor/therapeutic use
MH  - Recombinant Fusion Proteins/adverse effects/therapeutic use
MH  - Retrospective Studies
MH  - Treatment Outcome
PMC - PMC5417598
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2017/05/05 06:00
MHDA- 2017/09/16 06:00
PMCR- 2017/05/04
CRDT- 2017/05/05 06:00
PHST- 2016/10/12 00:00 [received]
PHST- 2017/03/11 00:00 [accepted]
PHST- 2017/05/05 06:00 [entrez]
PHST- 2017/05/05 06:00 [pubmed]
PHST- 2017/09/16 06:00 [medline]
PHST- 2017/05/04 00:00 [pmc-release]
AID - PONE-D-16-40700 [pii]
AID - 10.1371/journal.pone.0176899 [doi]
PST - epublish
SO  - PLoS One. 2017 May 4;12(5):e0176899. doi: 10.1371/journal.pone.0176899. 
      eCollection 2017.