Abstract
Gastrointestinal perforation is a possible, though rare, serious adverse effect of bevacizumab. We report a case in which multiple colonic perforations occurred four months after cessation of bevacizumab administration. A 62-year-old man underwent right hemi-colectomy for ascending colon cancer with multiple lung metastases and para-aortic lymph node metastases. Chemotherapy was started after the operation. Bevacizumab/FOLFIRI was given as second-line therapy, after FOLFOX4 as first-line therapy. The chemotherapy regimen was changed to cetuximab/CPT-11 after progression of the cancer. Multiple colonic perforations occurred on the 133rd day after cessation of bevacizumab administration, resulting in subtotal resection of the remaining colon. In the resected specimen, histopathological findings included vasculitis and thrombi in arterioles, venules and capillaries. Bevacizumab was highly suspected to have caused the colonic perforations seen in this case. This case highlights the possibility of colonic perforation occurring long after cessation of bevacizumab administration.
