Does the presence of an intact primary increase the risk of nonelective colorectal surgery in patients treated with bevacizumab?

Aim In patients with incurable metastatic colorectal cancer (mCRC), resection of the primary tumour is debated; however, patients with intact primaries may be at a higher risk of complications requiring surgery when receiving treatment with bevacizumab. Our aim was to estimate the risk of nonelectiv...

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Bibliographic Details
Published in:Colorectal disease 2020-12, Vol.22 (12), p.1974-1983
Main Authors: Baxter, N. N., Sutradhar, R., Dossa, F., Fu, L., Rochon, P., Wei, A. C., Kennedy, E. D., Earle, C. C.
Format: Article
Language:English
Subjects:
Bevacizumab
chemotherapy
Colorectal carcinoma
colorectal neoplasm
Colorectal surgery
Immunotherapy
Metastases
Monoclonal antibodies
Patients
Population studies
Surgery
Targeted cancer therapy
Tumors
Vigilance
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Summary:Aim In patients with incurable metastatic colorectal cancer (mCRC), resection of the primary tumour is debated; however, patients with intact primaries may be at a higher risk of complications requiring surgery when receiving treatment with bevacizumab. Our aim was to estimate the risk of nonelective colorectal surgery in patients undergoing bevacizumab therapy for mCRC and evaluate the association between intact primary tumours and risk of nonelective surgery. Method We designed a population‐based, retrospective cohort study using administrative and cancer registry data in Ontario, Canada. We included patients with mCRC who received bevacizumab from 1 January 2008 to 31 December 2014. The primary outcome was nonelective colorectal surgery after initiation of bevacizumab. We determined the cumulative incidence of nonelective colorectal surgery among patients with previously resected and unresected primaries, accounting for the competing risk of death. We explored the relationship between previous resection of the primary and need for nonelective surgery using a cause‐specific hazards model, controlling for patient, tumour and treatment factors. Results We identified 1840 (32.7%) patients with intact primaries and 3784 (67.3%) patients with prior resection. The cumulative incidence of nonelective surgery 1 year after initiating bevacizumab for all patients was 3.9% (95% CI 3.4–4.5%). One‐year cumulative incidence was higher in those with intact primaries than in those with resected primaries (6.1% vs 2.9%, P 
ISSN:1462-8910
1463-1318
DOI:10.1111/codi.15294