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Annals of Surgical Oncology

, Volume 21, Issue 8, pp 2517–2524 | Cite as

Surgical Outcome after Neoadjuvant Chemotherapy and Bevacizumab: Results from the GeparQuinto Study (GBG 44)

  • Bernd Gerber
  • Gunter von Minckwitz
  • Holger Eidtmann
  • Mahdi Rezai
  • Peter Fasching
  • Hans Tesch
  • Holm Eggemann
  • Iris Schrader
  • Kornelia Kittel
  • Claus Hanusch
  • Christine Solbach
  • Christian Jackisch
  • Georg Kunz
  • Jens-Uwe Blohmer
  • Jens Huober
  • Maik Hauschild
  • Valentina Nekljudova
  • Sibylle Loibl
  • Michael Untch
Breast Oncology

Abstract

Purpose

Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor, has shown increased pathological complete response rates when added to neoadjuvant chemotherapy. In various cancer types, bevacizumab treatment was accompanied by an increased risk of bleedings and other surgical complications. We assessed associated surgical complications.

Methods

In the GeparQuinto trial, 1,948 patients were randomized to receive four cycles epirubicin/cyclophosphamide (EC, 90/600 mg/m2 q3w) followed by four cycles docetaxel (D, 100 mg/m2 q3w) each with (ECB-DB) or without (EC-D) bevacizumab (B, 15 mg/kg q3w) concurrent with chemotherapy. Surgery had to be performed not earlier than 28 days after the last bevacizumab infusion, but within days 21 and 35 after the last chemotherapy.

Results

In 743 (38.1 %) patients, a surgical complication (bleedings, hematomas, necrosis, wound infections, abscess) was documented prospectively. Baseline characteristics of the patients were well balanced between both arms. The breast-conserving surgery (BCS) rate (N = 502) was 69.1 % (EC-D) and 71.9 % (ECB-DB; p = 0.464). The first surgical procedure was performed at a median of 29 (EC-D) and 34 days (ECB-DB) after last chemotherapy with or without bevacizumab infusion (p < 0.001). Surgical complications were documented in 38 (10.9 %; EC-D) and 59 (15.0 %; ECB-DB) patients (p = 0.103). Surgical complications were significantly higher after ECD-DB only in patients treated with BCS (N = 53; p = 0.029) or in those requiring repeat surgery in order achieve clear margins (N = 23; p = 0.037) compared to the EC-D group.

Conclusions

Addition of bevacizumab to neoadjuvant chemotherapy might be associated with an increased risk for surgical complications in patients treated with BCS or after repeated surgeries.

Keywords

Bevacizumab Chemotherapy Infusion Bevacizumab Treatment Bevacizumab Administration Wound Healing Disturbance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

We thank all patients and investigators for participation and Sanofi-Aventis and Roche, Germany, for financial support of this trial (NCT 00567554).

Disclosure

Gunter von Minckwitz has received honoraria and research found from Roche. Holger Eidtmann has received personal fees from Roche. Claus Hanusch has received personal fees from Novartis, Amgen, and Boeringer Ingelheim. Jens Blohmer has received honoraria from Roche. Jens Huober has received personal fees from Roche and Sanofi Aventis. Sibylle Loibl has received honoraria and research found from Roche. The other authors declare no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Bernd Gerber
    • 1
  • Gunter von Minckwitz
    • 2
    • 11
  • Holger Eidtmann
    • 3
  • Mahdi Rezai
    • 4
  • Peter Fasching
    • 5
  • Hans Tesch
    • 6
  • Holm Eggemann
    • 7
  • Iris Schrader
    • 8
  • Kornelia Kittel
    • 9
  • Claus Hanusch
    • 10
  • Christine Solbach
    • 11
  • Christian Jackisch
    • 12
  • Georg Kunz
    • 13
  • Jens-Uwe Blohmer
    • 14
  • Jens Huober
    • 15
  • Maik Hauschild
    • 16
  • Valentina Nekljudova
    • 2
  • Sibylle Loibl
    • 2
  • Michael Untch
    • 17
  1. 1.Department of Obstetrics and GynaecologyUniversity of RostockRostockGermany
  2. 2.Department Medicine and ResearchGerman Breast GroupNeu-IsenburgGermany
  3. 3.Department of Obstetrics and GynaecologyUniversity of Schleswig-Holstein, Campus KielKielGermany
  4. 4.Department of SenologyLuisen-HospitalDüsseldorfGermany
  5. 5.Department of Obstetrics and GynaecologyUniversity of ErlangenErlangenGermany
  6. 6.Department of OncologyBethanien-HospitalFrankfurtGermany
  7. 7.Department of Obstetrics and GynaecologyUniversity of MagdeburgMagdeburgGermany
  8. 8.Gynaeco-oncological PracticeHannoverGermany
  9. 9.Breast CenterElisabeth HospitalKasselGermany
  10. 10.Department of SenologyRotkreuz-KlinikumMunichGermany
  11. 11.Department of Obstetrics and GynaecologyJ.-W. Goethe-UniversityFrankfurtGermany
  12. 12.Department of Obstetrics and GynaecologyHospital OffenbachOffenbachGermany
  13. 13.St. Johannes HospitalDortmundGermany
  14. 14.Department of Obstetrics and GynaecologySankt Gertrauden HospitalBerlinGermany
  15. 15.Department of Obstetrics and GynaecologyHeinrich-Heine University DüsseldorfDüsseldorfGermany
  16. 16.Department of SenologyHospitalRheinfeldenGermany
  17. 17.Department of Obstetrics and GynaecologyHelios Klinikum Berlin-BuchBerlinGermany

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