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Risk and management of venous thromboembolisms in bevacizumab-treated metastatic colorectal cancer patients

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Abstract

Purpose

Bevacizumab may potentiate the risk of venous thromboembolisms (VTEs) in cancer patients, who are already predisposed to pro-thrombotic states. We aimed to characterize the incidence of VTEs in a population-based cohort of metastatic colorectal cancer (mCRC) patients treated with bevacizumab, describe patient and treatment factors associated with VTEs, and examine how VTEs are managed.

Methods

Patients diagnosed with mCRC from 2006 to 2009 and offered bevacizumab were included. Descriptive statistics were used to describe VTE occurrences and management. Univariate and multivariate regression models were constructed to explore associations between clinical factors and VTEs.

Results

We identified 541 mCRC patients: 27 never started bevacizumab and 15 were lost to follow-up. Of the 499 evaluable patients, median age was 61, 59.3 % were men, 88.1 % had ECOG 0/1, and 5.2 % reported previous VTEs. Mean number of bevacizumab doses was 13.3 cycles. After receiving bevacizumab, 81 patients developed 93 cases of VTEs, with 9 patients experiencing >1 event. Individuals who experienced VTEs were more likely to have had pre-existing cardiovascular disease (OR 2.259, p = 0.0245), resection of primary cancer (OR 3.262, p = 0.0269), pre-chemotherapy platelet count ≥350,000/μL (OR 2.295, p = 0.0293), and received >12 bevacizumab cycles (OR 2.172, p = 0.0158). Use of bevacizumab varied after occurrence of VTE where it was discontinued in 34.4 %, continued in 34.4 %, and temporarily held in 1.1 %.

Conclusions

VTE risk can be high, especially in patients with specific pre-treatment risk factors as well as in those who received more bevacizumab, suggesting a potential dose-related effect. Management of bevacizumab-related VTEs was variable.

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Acknowledgments

Authors would like to gratefully acknowledge the British Columbia Cancer Foundation and the Canadian Cancer Society Research Institute for their support in making this research possible.

Funding

This study was funded by the British Columbia Cancer Foundation and the Canadian Cancer Society Research Institute.

Conflicts of interest

The authors of the paper declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada

    Irene Yu

  2. Division of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, 4th Floor, Vancouver, BC, V5Z 4E6, Canada

    Leo Chen, Jenny Y. Ruan, Jennifer T. Chang & Winson Y. Cheung

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  1. Irene Yu
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  2. Leo Chen
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  4. Jennifer T. Chang
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Corresponding author

Correspondence to Winson Y. Cheung.

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Yu, I., Chen, L., Ruan, J.Y. et al. Risk and management of venous thromboembolisms in bevacizumab-treated metastatic colorectal cancer patients. Support Care Cancer 24, 1199–1208 (2016). https://doi.org/10.1007/s00520-015-2899-y

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  • DOI: https://doi.org/10.1007/s00520-015-2899-y

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