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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2011

01-03-2011 | Breast Oncology

Does Neoadjuvant Bevacizumab Increase Surgical Complications in Breast Surgery?

Authors: M. Golshan, MD, J. E. Garber, MD, R. Gelman, PhD, Nadine Tung, MD, B. L. Smith, MD, PhD, S. Troyan, MD, C. C. Greenberg, MD, E. P. Winer, MD, P. Ryan, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2011

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Abstract

Background

Neoadjuvant chemotherapy is being increasingly used in operable breast cancer. There are limited data on the safety of bevacizumab (bev) in the neoadjuvant setting. We sought to explore the safety of neoadjuvant cisplatin/bev in a protocol for triple negative breast cancer (TNBC).

Materials and Methods

A total of 51 patients with confirmed TNBC were enrolled in a single-arm trial of neoadjuvant cisplatin plus bev. Of the 51 patients, 28 with confirmed TNBC were enrolled in our trial of single-agent neoadjuvant cisplatin. Two-sided Fisher exact test were used for comparing the 2 trials.

Results

The 51 patients received neoadjuvant protocol therapy with cisplatin/bev and underwent definitive local therapy. Breast conserving therapy (BCT) was performed in 29 (57%) and mastectomy with or without reconstruction in 22 (43%). Postoperative complications were reported in 22 patients (43%); 4 (8%) required explanation of expanders. Also, 28 patients completed neoadjuvant cisplatin therapy. BCT was performed in 13 (46%) and mastectomy with or without reconstruction in 15 (54%). Postoperative complications were reported in 11 patients (39%). None of the 5 reconstructions were lost. We compared all toxicities between the two trials (P = .81 NS), and wound healing related complications between the two trials (P = .10 NS).

Conclusions

Cisplatin/bevacizumab and cisplatin alone neoadjuvant therapy resulted in a significant number of postoperative complications. Specifically, use of expanders/implants may be problematic for patients treated with bev. However, this was a single-arm trial; randomized controlled studies will be needed to determine the optimal use of bevacizumab in the timing of breast cancer surgery.
Literature
1.
Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Projects B-18 and B-27. J Clin Oncol. 2008;26:778–85.PubMedCrossRef
2.
van Nes JG, Putter H, Julien JP, Tubiana-Hulin M, van de Vijver M, Bogaerts J, et al. Preoperative chemotherapy is safe in early breast cancer, even after 10 year of follow-up; clinical and translational results from the EORTC trial 10902. Breast Cancer Res Treat. 2009;115:101–13.PubMedCrossRef
3.
Throckmorton AD, Hoskin T, Boostrom SY, Boughey JC, Holifield AC, Stobbs MM, et al. Complications associated with postoperative antibiotic prophylaxis after breast surgery. Am J Surg. 2009;198:553–6.PubMedCrossRef
4.
Dvorak HF. Vascular permeability factor/vascular endothelial growth factor: a critical cytokine in tumor angiogenesis and therapy. J Clin Oncol. 2002;20:4368–80.PubMedCrossRef
5.
Jain RK. Antiangiogenic therapy for cancer: current and emerging concepts. Oncology. 2005;19:7–16.PubMed
6.
Schneider BP, Wang M, Radovich M, Sledge GW, Badve S, Thor A, et al. Association of vascular endothelial growth factor and vascular endothelial growth and vascular endothelial growth factor receptor-2 genetic polymorphisms with outcome in a trial of paclitaxel compared with paclitaxel plus bevacizumab in advanced breast cancer: ECOG 2100. J Clin Oncol. 2008;26:4672–8.PubMedCrossRef
7.
Miles D, Chan A, Romieu G, Dirix LY, Cortes J, Pivot X, et al. Randomized, double-blind, placebo-controlled, phase III study of bevacizumab with docetaxel or docetaxel with placebo as first-line therapy for patients with locally recurrent or metastatic breast cancer (mBC): AVADO. J Clin Oncol. 2008;26:LBA1011.
8.
Gordon CR, Rojavin Y, Patel M, Zins JE, Grana G, Kann B, et al. A review on bevacizumab and surgical wound healing: an important warning to all surgeons. Ann Plast Surg. 2009;62:707–9.PubMedCrossRef
9.
Kabbinavar F, Hurwitz HI, Fehrenbacher L, Meropol NJ, Novotny WF, Lieberman G, et al. Phase II, randomized trial comparing bevacizumab plus fluorouracil (FU)/leucovorin (LV) with FU/LV alone in patients with metastatic colorectal cancer. J Clin Oncol. 2003;21:60–5.PubMedCrossRef
10.
Scappaticci FA, Skillings JR, Holden SN, Gerber HP, Miller K, Kabbinavar F, et al. Arterial thrombo-embolic events in patients with metastatic carcinoma treated with chemotherapy and bevacizumab. J Natl Cancer Inst. 2007;99:1232–9.PubMedCrossRef
11.
Wedam SB, Low JA, Yang SX, Chow CK, Choyke P, Danforth D, et al. Antiangiogenic and antitumor effects of bevacizumab in patients with inflammatory and locally advanced breast cancer. J Clin Oncol. 2006;24:769–7.
12.
Motwani SB, Strom EA, Schechter NR, Butler CE, Lee GK, Langstein HN, et al. The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66:76–82.PubMedCrossRef
13.
Pomahac B, Recht A, May JW, Hergrueter CA, Slavin SA. New trends in breast cancer management: is the era of immediate breast reconstruction changing? Ann Surg. 2006;244:282–8.PubMedCrossRef
14.
El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standard of care. Ann Surg. 2007;245:665–71.PubMedCrossRef
15.
Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA, et al. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med. 2007;357:2666–76.PubMedCrossRef
16.
Howdieshell TR, Callaway D, Webb WL, Gaines MD, Procter CD Jr, Sathyanarayana, et al. Antibody neutralization of vascular endothelial growth factor inhibits wound granulation tissue formation. J Surg Res. 2001;96:173–82.PubMedCrossRef
17.
Kabbinavar F, Hurwitz HI, Fehrenbacher L, Meropol NJ, Novotny WF, Lieberman G, et al. Phase II, randomized trial comparing bevacizumab plus fluorouracil (FU)/leucovorin (LV) with FU/LV alone in patients with metastatic colorectal cancer. J Clin Oncol. 2004;21:60–5.CrossRef
18.
Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Eng J Med. 2004;450:2335–42.CrossRef
19.
Hurwitz H, Fehrenbacher L, Cartwright T, Hainsworth J, Heim W, Berlin J, et al. Wound healing/bleeding in metastatic colorectal cancer patients who undergo surgery during treatment with bevacizumab. J Clin Oncol. 2004;22:3702.
20.
Scappaticci FA, Fehrenbacher L, Cartwright T, Hainsworth JD, Heim W, Berlin J, et al. Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab. J Surg Oncol. 2005;91:173–80.PubMedCrossRef
21.
Deshaies I, Malka D, Soria JC, Massard C, Bahleda R, Elias D. Antiangiogenic agents and late anastomotic complications. J Surg Oncol. 2010;101:180–3.PubMed
Metadata
Title
Does Neoadjuvant Bevacizumab Increase Surgical Complications in Breast Surgery?
Authors
M. Golshan, MD
J. E. Garber, MD
R. Gelman, PhD
Nadine Tung, MD
B. L. Smith, MD, PhD
S. Troyan, MD
C. C. Greenberg, MD
E. P. Winer, MD
P. Ryan, MD, PhD
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 3/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1366-8

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