PMID- 33490199
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210126
IS  - 2305-5839 (Print)
IS  - 2305-5847 (Electronic)
IS  - 2305-5839 (Linking)
VI  - 8
IP  - 24
DP  - 2020 Dec
TI  - Extreme complications related to bevacizumab use in the treatment of ovarian 
      cancer: a case series from a III level referral centre and review of the 
      literature.
PG  - 1687
LID - 10.21037/atm-20-4448 [doi]
LID - 1687
AB  - In patients undergoing debulking surgery for ovarian cancer (OC), 
      bevacizumab-combined chemotherapy has been reported to be associated with an 
      increased incidence of adverse events (AEs). Reports in the literature have noted 
      the overall morbidity of bevacizumab to be between 3.7% and 9%. The aim of this 
      study is to report uncommon and unusual manifestations of morbidity in surgical 
      cases performed at our third level referral centers for gynecologic oncology. 
      Additionally, we review the rare and severe bevacizumab-related complications 
      that have been described in the literature. We defined as "extreme", the 
      particularly rare and/or severe complications up to determining a 
      life-threatening condition or death, which are related to the use of bevacizumab. 
      A case-series of extreme complications registered at our institutions were 
      reported. In addition, a literature search of the PubMed, MEDLINE and EMBASE 
      electronic databases was performed for this review. The studies collected 
      included: 8 randomized controlled trials (RCT) and 5 prospective observational, 1 
      prospective phase-IV, 10 prospective phase-II, 2 prospective phase-I, and 20 
      retrospective studies, as well as 9 case reports. Bevacizumab was administered as 
      primary treatment in adjuvant and neo-adjuvant setting in 16 and 5 studies 
      respectively, as treatment for recurrence in 36 trials, and for secondary 
      cytoreductive surgery (SCS) in 3 studies. The overall population administered 
      with bevacizumab numbered 7,096 women. Extreme complications were observed in 591 
      patients, with a morbidity rate of the 8.3%. Overall, central nervous system 
      (CNS), cardiovascular, gastrointestinal (GI) and primary infectious complications 
      were seen in 22 patients (0.3%), 261 patients (3.7%), 159 patients (2.2%), and 8 
      patients (0.13%), respectively. Hemorrhagic and wound complications occurred in 
      18 women (0.25%), and 112 women (1.6%), respectively. Extreme complications 
      related to the use of bevacizumab are rare, and often go unrecognized. The 
      recognition and immediate management of such rare and life-threatening 
      complications in patients treated at third level referral centers could 
      significantly improve patient survival.
CI  - 2020 Annals of Translational Medicine. All rights reserved.
FAU - Turco, Luigi Carlo
AU  - Turco LC
AD  - Mater Olbia Hospital, Gynaecology and Breast Unit, Olbia.
AD  - Division of Gynecologic Oncology, Gemelli-Molise, Universita Cattolica del Sacro 
      Cuore, Campobasso, Italia.
FAU - Ferrandina, Gabriella
AU  - Ferrandina G
AD  - Department of Woman's, Children's and Public Health, Fondazione Policlinico 
      Universitario A. Gemelli IRCCS, Roma, Italia.
AD  - Universita Cattolica del Sacro Cuore, Roma, Italia.
FAU - Vargiu, Virginia
AU  - Vargiu V
AD  - Department of Woman's, Children's and Public Health, Fondazione Policlinico 
      Universitario A. Gemelli IRCCS, Roma, Italia.
FAU - Cappuccio, Serena
AU  - Cappuccio S
AD  - Department of Woman's, Children's and Public Health, Fondazione Policlinico 
      Universitario A. Gemelli IRCCS, Roma, Italia.
FAU - Fagotti, Anna
AU  - Fagotti A
AD  - Department of Woman's, Children's and Public Health, Fondazione Policlinico 
      Universitario A. Gemelli IRCCS, Roma, Italia.
AD  - Universita Cattolica del Sacro Cuore, Roma, Italia.
FAU - Sallustio, Giuseppina
AU  - Sallustio G
AD  - Universita Cattolica del Sacro Cuore, Roma, Italia.
AD  - Department of Radiology and Diagnostic Imaging, Gemelli-Molise, Universita 
      Cattolica del Sacro Cuore, Campobasso, Italia.
FAU - Scambia, Giovanni
AU  - Scambia G
AD  - Department of Woman's, Children's and Public Health, Fondazione Policlinico 
      Universitario A. Gemelli IRCCS, Roma, Italia.
AD  - Universita Cattolica del Sacro Cuore, Roma, Italia.
FAU - Cosentino, Francesco
AU  - Cosentino F
AD  - Division of Gynecologic Oncology, Gemelli-Molise, Universita Cattolica del Sacro 
      Cuore, Campobasso, Italia.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - China
TA  - Ann Transl Med
JT  - Annals of translational medicine
JID - 101617978
PMC - PMC7812204
OTO - NOTNLM
OT  - Bevacizumab
OT  - case series
OT  - complications
OT  - ovarian cancer (OC)
OT  - translational medicine/personalized medicine
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at http://dx.doi.org/10.21037/atm-20-4448). LCT serves as an 
      unpaid editorial board member of Annals of Translational Medicine from Mar 2020 
      to Feb 2022. The other authors have no conflicts of interest to declare.
EDAT- 2021/01/26 06:00
MHDA- 2021/01/26 06:01
PMCR- 2020/12/01
CRDT- 2021/01/25 05:45
PHST- 2021/01/25 05:45 [entrez]
PHST- 2021/01/26 06:00 [pubmed]
PHST- 2021/01/26 06:01 [medline]
PHST- 2020/12/01 00:00 [pmc-release]
AID - atm-08-24-1687 [pii]
AID - 10.21037/atm-20-4448 [doi]
PST - ppublish
SO  - Ann Transl Med. 2020 Dec;8(24):1687. doi: 10.21037/atm-20-4448.