TITLE:
Bowel Perforation Following Continuation of Bevacizumab Post Nasal Septal Perforation―A Case Report
AUTHORS:
D. J. Nelmes, S. H. Gwynne
KEYWORDS:
Colorectal Cancer, Bevacizumab, Avastin, Nasal, Septal, Perforation
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.5,
May
20,
2014
ABSTRACT: We report the case
of a 63-year-old male with an inoperableT4N1 adenocarcinoma of colon, K-RAS mutant, who received first line
chemotherapy with capecitabine and oxaliplatin. A CT scan following 4 cycles demonstrated
progressive disease, and second line therapy with capecitabine, irinotecan and
bevacizumab was commenced. CT scans at 3 and 6 months during this treatment
regime demonstrated radiologically stable disease, and therefore the treatment was
continued. The patient developed nasal septal perforation, a rare but
recognised complication of bevacizumab therapy, which was managed
conservatively. Here we highlight that no consensus exists on whether
bevacizumab should be continued in this situation. After a detailed discussion
about the risks and benefits, this patient continued on with the same
therapeutic regime. However, eight weeks later, this patient then developed a
localised tumour perforation, necessitating an emergency admission to his local
hospital. We recommend caution in continuing bevacizumab in patients with
colorectal cancer following a nasal septal perforation and advise a detailed
discussion of risk with the patient, especially when the primary tumour remains in-situ.