Safety of endoscopy after recent bevacizumab use in metastatic colorectal cancer

Bevacizumab improves metastatic colorectal cancer (mCRC) survival but increases risks including GI perforation. This study compared 30-day postendoscopy (EGD/colonoscopy) perforation and bleeding risks between mCRC patients receiving recent (≤1 month) bevacizumab versus other active chemotherapy.

TriNetX, a multinational federated electronic health network database, was used to create and analyze 1:1 propensity score-matched cohorts of patients who underwent endoscopy for either diagnostic purposes (n = 396 total postmatch) or therapeutic purposes (n = 1306) as well as combined (n = 2100). Time-to-event analysis on 30-day perforation risk and 30-day postprocedural bleeding was conducted using Kaplan-Meier analysis on matched cohorts as well as adjusted Cox proportional hazards models on unmatched cohorts for sensitivity analysis.

Baseline covariates were balanced post matching. No significant difference in 30-day perforation risk was found (Combined: hazard ratio [HR], 0.93; P = .791; Diagnostic: HR, 2.33; P = .143; Therapeutic: HR, 0.96; P = .925). Bevacizumab was associated with a significantly higher 30-day postprocedural bleeding risk in the Combined (matched HR, 1.28; P = .006) and Therapeutic (matched HR, 1.45; P = .001; adjusted HR, 1.46; P < .001) analyses but not in the Diagnostic subgroup (matched HR, 1.03; P = .894; adjusted HR, 0.98; P = .921).

Recent bevacizumab exposure was not associated with increased 30-day postendoscopy perforation risk compared with other active chemotherapy, but was associated with higher bleeding risk, primarily in therapeutic (specifically EGD) procedures.