[Bowel perforation associated with bevacizumab therapy in recurrent ovarian cancers without bowel obstruction or...

Recent reports showed that bevacizumab, a humanized recombinant antibody binding to vascular endothelial growth factor (VEGF), harbored a significant activity in advanced or recurrent epithelial ovarian cancers. However, life-threatening complications including arterial thrombosis, pulmonary hemorrhage, and gastrointestinal perforation (GIP) are not negligible. A Japanese case of bowel perforation associated with bevacizumab treatment in heavily pretreated ovarian cancers is reported. The case affected with refractory ovarian cancer had no signs of bowel obstruction and bowel thickness which are now recognized as risk factors of GIP associated with bevacizumab. After obtaining a written informed consent, a combination of weekly paclitaxel and weekly bevacizumab was administered as the fourth-line therapy. After nine cycles of the regimen, the case developed GIP, although the recurrent tumor showed a stable disease. After conservative therapy for two months, the patient died. The case was severely pretreated; however, there seemed to be no risk factors for GIP. Therefore, we do recommend that special cautions are required for the bevacizumab- based chemotherapy, especially severely pretreated ovarian cancer patients.