Perioperative Bevacizumab for Resection of Hepatic Colorectal Metastases

Summary and Comment |
January 8, 2007

Perioperative Bevacizumab for Resection of Hepatic Colorectal Metastases

  1. Henry Mark Kuerer, MD, PhD, FACS

Bevacizumab at 6 to 8 weeks before or after hepatectomy seems to be safe.

  1. Henry Mark Kuerer, MD, PhD, FACS

Bevacizumab (Avastin) is a humanized anti–vascular endothelial growth factor (VEGF) monoclonal antibody that is FDA-approved for first-line therapy in metastatic colorectal cancer. Addition of bevacizumab to systemic chemotherapy regimens is associated with improved response and survival rates; however, adverse events, such as bleeding, thrombosis, hypertension, bowel perforation, and proteinuria, are associated with bevacizumab use. No prospective evidence is available about whether administration of bevacizumab-plus-chemotherapy regimens before or after partial hepatectomy for metastatic colorectal cancer benefits recipients, but the practice seems logical and often is used in standard practice. Nevertheless, because VEGF is centrally involved in wound healing and liver regeneration, important questions remain about the safety of bevacizumab use in hepatectomy patients.

Researchers at Memorial Sloan-Kettering Cancer Center evaluated perioperative outcomes for 32 patients who underwent partial hepatectomy for metastatic colorectal cancer and who received bevacizumab preoperatively, postoperatively, or both. Seventeen of the patients underwent major hepatic resections, and 9 had simultaneous colorectal resections. The median time between bevacizumab administration and surgery was 6.9 weeks (range, 3–15) before and 7.4 weeks (range, 5–15) after surgery.

No postoperative deaths were reported. Postoperative morbidities occurred in 13 patients (40%), with major complications in 2 patients. No severe intraoperative or postoperative bleeding, wound breakdown, bowel perforation, or hepatic dysfunction occurred. Compared with a group of historical controls matched for age, sex, and extent of hepatectomy, bevacizumab patients experienced no significant difference in perioperative morbidity.

Comment

These data, along with the known half-life of bevacizumab (range, 11–50 days), support the concept that bevacizumab is safe to administer at 6 to 8 weeks before or after partial hepatectomy. Treatment of patients with metastatic colorectal cancer is changing dramatically because of improving chemotherapy and surgery techniques. Novel combinations of these treatment modalities are critical to ongoing enhancement of success rates. Surgeons and medical oncologists must continue to work closely together to evaluate outcomes of multi-modal treatments and to assess the effects of these combined therapies on perioperative morbidity. This study is an early report, with a relatively small number of patients; thus, ongoing safety assessments are critically important.

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