Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review

Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review

Can J Surg 2015;58(3):167-71 | PDF

Amal Imbulgoda, MD; Anthony MacLean, MD; John Heine, MD; Sebastien Drolet, MD; Michael M. Vickers, MD, MPH

Abstract

Background: Self-expanding metal stents (SEMS) are increasingly used in the treatment of malignant large bowel obstruction in the setting of inoperable colorectal cancer. Perforation is a well-known complication associated with these devices. The addition of the vascular endothelial growth factor inhibitor bevacizumab is suspected to increase the rate, but the extent of the increase is not known.

Methods: We retrospectively reviewed the records of patients receiving SEMS in tertiary hospitals in Calgary, Alta., between October 2001 and January 2012.

Results: We reviewed the records of 87 patients with inoperable colorectal cancer who received SEMS during our study period. Nine perforations occurred in total: 4 of 30 (13%) patients who received no chemotherapy, 3 of 47 (6%) who received chemotherapy but no bevacizumab, and 2 of 10 (20%) who received chemotherapy and bevacizumab. These two patients received bevacizumab with FOLFIRI after SEMS placement, and they had peritoneal disease.

Conclusion: Our case series and other studies suggest that bevacizumab may increase the risk of colonic perforation in the setting of SEMS. Caution should be used when combining these therapies.

Résumé

Contexte : Les endoprothèses métalliques auto-expansibles (EMAE) sont de plus en plus utilisées pour le traitement de l’obstruction colique d’origine maligne dans le contexte d’un cancer colorectal inopérable. La perforation est une complication bien connue de ces dispositifs et on soupçonne que l’ajout de l’inhibiteur du facteur de croissance de l’endothélium vasculaire bevacizumab en accroît le taux, mais l’ampleur de cette augmentation est inconnue.

Méthodes : Nous avons passé en revue de manière rétrospective les dossiers de patients traités par EMAE dans des hôpitaux de soins tertiaires de Calgary, en Alberta, entre octobre 2001 et janvier 2012.

Résultats : Nous avons examiné les dossiers de 87 patients atteints d’un cancer colorectal inopérable ayant reçu une EMAE durant la période de notre étude. En tout, 9 perforations ont été enregistrées, soit chez 4 patients sur 30 (13 %) qui n’avaient pas reçu de chimiothérapie, chez 3 patients sur 47 (6 %) traités par chimiothérapie sans bevacizumab et chez 2 patients sur 10 (20 %) ayant reçu une chimiothérapie et du bevacizumab. Ces 2 patients avaient été traités par bevacizumab avec FOLFIRI après la pose de l’EMAE et présentaient une atteinte péritonéale.

Conclusion : Selon notre série de cas et d’autres études, le bevacizumab pourrait accroître le risque de perforation du côlon dans le contexte de l’EMAE. La prudence s’impose lorsqu’on utilise ces traitements concomitamment.


Accepted for publication Nov. 11, 2014

Early-released on Apr. 1, 2015; subject to revision

Affiliations: From the Department of Oncology, University of Calgary, Calgary, Alta (Imbulgoda); the Department of Surgery, University of Calgary, Calgary, Alta. (MacLean, Heine); the Department of Surgery, Université Laval, Québec, Que. (Drolet); and the Department of Medicine, Division of Medical Oncology, University of Ottawa, Ottawa, Ont. (Vickers).

Competing interests: None declared.

Contributors: A. Imbulgoda, A. MacLean, J. Heine and M. Vickers designed the study. A. Imbulgoda, A. MacLean and S. Drolet acquired the data, which A. Imbulgoda and M. Vickers analyzed. A. Imbulgoda and M. Vickers wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.013014

Correspondence to: M.M. Vickers, The Ottawa Hospital Cancer Centre, Division of Medical Oncology, 501 Smyth Rd., Ottawa, ON, K1H 8L6; mvickers@toh.on.ca