When do you feel comfortable adding bevacizumab to a BRAF-WT, KRAS-mutated colon cancer patient with previously hemorrhagic brain mets that responded to radiation?

> 30s, female with metastatic colon cancer. Presented with a headache. Metastatic hemorrhagic mets per MRI 10/2022. Had radiation. Kras mutated, Braf wild type. Now on systemic chemo without Avastin. MRI 4/2023 smaller metastases without hemorrhage, largest 1.4 cm, no edema. When to add Avastin? Thanks

Answer from: Medical Oncologist at Academic Institution

It should be safe to add bevacizumab at this time. Radiation will reduce vascularity after 4-6 weeks. The incidence of bleeding with Bev (in the absence of anticoagulation) is quite low. Actually lower than the risk of thrombosis or wound healing complications. Go for it.

Comments

Medical Oncologist at St. Francis Hospital
Thanks

Answer from: Medical Oncologist at Academic Institution

Completely agree with Dr. @Hochster. Colorectal cancer patients with brain metastatic disease are rare (a recent systemic review reported incidence of about 2.1%) (Müller et al., PMID 33669974) so data for this specific population is limited. However, there is a recent meta-analysis of bev...

Comments

Medical Oncologist at St. Francis Hospital
Thanks

Please select the option that best describes you:

When do you feel comfortable adding bevacizumab to a BRAF-WT, KRAS-mutated colon cancer patient with previously hemorrhagic brain mets that responded to radiation?

Related Questions