P0480 (S0261). - Does Bevacizumab Increase the Risk of Colonic Perforation With Placement Self-Expandable Metal Stents (SEMS) in Patients With Obstructive Colorectal Cancer? A Systematic Review and Meta-Analysis
Ayusa Sinha, MD1, Umair Iqbal, MD1, Harshit S. Khara, MD, FACG1, Hafsa Anwar, MD2, Khwaja F. Haq, MD3, Muhammad Ali Khan, MD4, Matthew Shellenberger, DO1, Mohammad Ismail, MD5; 1Geisinger Medical Center, Danville, PA; 2Capital Health Medical Center, Hopewell Township, NJ; 3Henry Ford Hospital/Wayne State University, Detroit, MI; 4University of Alabama, Birmingham, AL; 5University of Tennessee Health Science Center, Memphis, TN
Introduction: Self-expandable metal stents (SEMS) prevent the need for emergent surgery in patients with malignant colorectal obstruction (MCO). Colonic perforation is a risk factor for SEMs, which is heightened by the addition of bevacizumab, a monoclonal antibody shown to increase survival in colorectal cancer. However, some recent well-done studies showed no increased risk of colonic perforation with placement of SEMS in these patients on bevacizumab-based chemotherapy. We therefore conducted a systematic review and meta-analysis to evaluate the effect of bevacizumab on SEMS outcomes. Methods: We conducted a systematic literature search on several databases including PubMed, Embase and Ovid Medline until January 2020. We identified all potential studies that evaluated the risk of colonic perforation in patients with SEMS for MCO not on concomitant bevacizumab chemotherapy as compared to patients on bevacizumab chemotherapy. A random-effects model was utilized for this meta-analysis, with point estimates, variance and weights for each study based on the size of the study and the number of events. All the analysis was performed using RevMan 5.3 software. Results: Twenty-three studies including 2337 patients met our inclusion criteria and were included in the meta-analysis. Out of 2337 SEMS patients, 1961 were not on bevacizumab therapy and 376 received chemotherapy regimen consisting of bevacizumab. Bevacizumab therapy significantly increased the risk of colonic perforation in patients with MCO requiring SEMS placement with pooled OR=3.02 [1.48-6.17] with moderate statistical heterogeneity as calculated by I2=51%. In the randomized controlled trials (RCTs, N=2), there were no significant differences between the risk of perforation with SEMS placement in patients on bevacizumab compared to patients with SEMS placement not on bevacizumab with pooled OR=2.67 [0.24-29.20] with no heterogeneity I2=0%. Discussion: Our study showed bevacizumab significantly increases the risk of colonic perforation in patients with MCO who have undergone SEMS placement for the palliation of obstructive symptoms. This data will help both for the endoscopist placing the SEMS as well as the oncologist managing the chemotherapy to make an informed decision with the patient undergoing the treatment. Larger RCTs are needed to further delineate the association between increased risk of colonic perforation with SEMS placement in patients on bevacizumab chemotherapy.
Disclosures: Ayusa Sinha indicated no relevant financial relationships. Umair Iqbal indicated no relevant financial relationships. Harshit Khara indicated no relevant financial relationships. Hafsa Anwar indicated no relevant financial relationships. Khwaja Haq indicated no relevant financial relationships. Muhammad Ali Khan indicated no relevant financial relationships. Matthew Shellenberger indicated no relevant financial relationships. Mohammad Ismail indicated no relevant financial relationships.