Predicting and managing the risk of pulmonary haemorrhage in patients with NSCLC treated with bevacizumab: a consensus report from a panel of experts
Open Access
- 4 November 2011
- journal article
- research article
- Published by Elsevier BV in Annals Of Oncology
- Vol. 23 (5), 1111-1120
- https://doi.org/10.1093/annonc/mdr463
Abstract
Bevacizumab is a monoclonal antibody against vascular endothelial growth factor. Severe pulmonary haemorrhage (PH) is a rare but serious potential adverse event associated with bevacizumab therapy for advanced non-squamous non-small-cell lung cancer (NSCLC). A panel of expert oncologists, pulmonologists and radiologists reviewed the available data to identify predictive factors for PH in order to help guide physicians using bevacizumab in patients with NSCLC. Patients with NSCLC are at an increased risk of PH owing to the underlying disease process. Patients with squamous histology and/or a history of grade ≥2 haemoptysis (≥2.5 ml per event) should not receive bevacizumab. No clinical or radiological features (including cavitation and central tumour location) reliably predict severe PH in bevacizumab-treated patients. Major blood vessel infiltration and bronchial vessel infiltration, encasement and abutting may predict PH; however, standardised radiological criteria for defining infiltration have not been established. Eligibility for bevacizumab is not affected by patient age, performance status or anticoagulation or antiplatelet therapy. An individualised risk–benefit assessment should be undertaken in all patients with NSCLC in whom bevacizumab is being considered. Further research is required to elucidate the mechanisms underlying PH and the clinical risk factors.Keywords
This publication has 54 references indexed in Scilit:
- Systematic review and meta-analysis of randomised, phase II/III trials adding bevacizumab to platinum-based chemotherapy as first-line treatment in patients with advanced non-small-cell lung cancerAnnals of Oncology, 2013
- Bleeding events in bevacizumab-treated cancer patients who received full-dose anticoagulation and remained on studyBritish Journal of Cancer, 2011
- Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry dataThe Lancet, 2011
- Inter- and intraobserver consistency in assessing eligibility for bevacizumab (BVZ) in non-small-cell lung cancer (NSCLC) patients with centrally located tumorsAnnals of Oncology, 2010
- Overall survival with cisplatin–gemcitabine and bevacizumab or placebo as first-line therapy for nonsquamous non-small-cell lung cancer: results from a randomised phase III trial (AVAiL)Annals Of Oncology, 2010
- Targeting tumorigenesis: development and use of mTOR inhibitors in cancer therapyJournal of Hematology & Oncology, 2009
- Retrospective Evaluation of the Clinical and Radiographic Risk Factors Associated With Severe Pulmonary Hemorrhage in First-Line Advanced, Unresectable Non–Small-Cell Lung Cancer Treated With Carboplatin and Paclitaxel Plus BevacizumabJournal of Clinical Oncology, 2009
- Mechanisms of adverse effects of anti-VEGF therapy for cancerBritish Journal of Cancer, 2007
- Bronchoscopy-Guided Topical Hemostatic Tamponade Therapy for the Management of Life-Threatening HemoptysisSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2005
- Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT.American Journal of Roentgenology, 1997