Category: Federal Forum Posters
Purpose: Majority of cancer patients are presented with advanced disease, which require systemic treatment. Since angiogenesis is one of the cancer hallmarks, targeting it, is crucial to improve survival. Bevacizumab is a recombinant humanized monoclonal IgG1 antibody and anti vascular endothelial growth factor (VEGF) that inhibits tumor survival. It has been approved by the FDA and NCCN guidelines for the treatment of certain recurrent and metastasised malignancies until disease progression or unacceptable toxicity. The most common reported adverse effects are hypertension, GI proliferation and thrombosis. The aim is to evaluate the appropriateness of its use and incidence of toxicities.
Methods: A retrospective observational chart review of all cancer patients received bevacizumab between October 2017 and March 2018. The study was approved by the Hospital Ethics Committee. Patients demographics, indication and stage of cancer, line of Bevacizumab, chemotherapy used in combination, in addition to the adverse reaction reported were documented. Computerised patient records were used to collect data on patients demographics.
Results: The medical charts of 84 patients were reviewed. Twenty-five patients received bevacizumab in advanced/recurrent ovarian carcinoma, while 53 received for other malignancies including metastatic colorectal and lung adenocarcinoma.
Two patients out of the 84 have received bevacizumab beyond progression (1 in glioblastoma, 1 in lung adenocarcinoma). With regards to the doses; 6 patients received lower doses than recommended and the rest 53 received the doses appropriately. In recurrent/advanced ovarian cancer; 2 patients out of 25 received bevacizumab in recurrent disease after prior use in previous lines, which is currently not supported by evidence as per the NCCN guidelines. Six patients out of 25 received bevacizumab in upfront line. Out of those, 3 patients received dose of 7.5mg/kg and the other 3 received 15mg/kg. In the subsequent lines 9 patients received 15mg/kg, one patient received 10mg/kg and 6 patients received dose of 7.5mg/kg. The most common chemotherapy combination was carboplatinum containing regimen. Regarding the toxicity, bevacizumab was found to be associated with significant adverse effects; 3 patients developed high blood-pressure, 3 patients required discontinuation of bevacizumab (1 patient with epistaxis, 1 with proteinuria and 1 had myocardial infarction). Two patients developed rectal and GI bleeding and 3 patients developed thrombocytopenia.
Conclusion: Our study showed that bevacizumab was used according to guidelines in the majority of patients.
In addition, this study showed that significant number of patients developed toxicities associated with bevacizumab use. Therefore, close monitoring and patient follow up as well as proper patient and family education are important factors that help detect early signs of toxicity and intervene immediately if needed.
Asma Saeed Bin Ishaq– Pharmacy Resident, Pharmacist, Al Ain, United Arab Emirates