New side-effect of cancer therapy? The author’s perspective

gurjal-becavizumbBevacizumab, the popular colorectal cancer and non-small cell lung cancer therapy antibody, has shown signs of a previously unreported side-effect. Dr Dorothy Gujral, St Lukes Cancer Centre, Royal Surrey County Hospital, reports the first case of periodontitis in a patient whilst receiving bevacizumab. She reports, “This case is, to the best of our knowledge, the first report of a patient developing periodontal disease whilst receiving bevacizumab. Although it would be difficult to exclude all other risk factors in this patient, the onset of periodontal disease on commencement of bevacizumab and that the disease remained stable on discontinuation of the drug points to this as the cause.”

We know that bevacizumab has been linked to hypertension and bowel perforations, and that the The Food and Drug Administration voted to reject the use of bevacizumab for breast cancer therapy in December 2007 – but does its safety record need further investigation in light of the new finding of suspected bevacizumab-induced periodontal disease? Trials are underway already; this particular patient was  enrolled  in a randomised, double-blind, multicentre, 2-stage, phase III study: the AVAiL  trial  (AVAstin  In Lung  cancer  – Trial No. BO17704) – a study in which the primary objective is to evaluate safety and efficacy of  two doses  of  bevacizumab  in  combination  with  gemcitabine  and  cisplatin  and determine the optimal dose of bevacizumab. Dorothy Gurjal comments: “We continue to use bevacizumab in this setting but patients now receive pre-treatment and follow up dental examinations and are advised on good dental care.”

Patient follow-up

The patient in question in this new case report has now completed the course of bevacizumab; the periodontal disease has subsequently remained stable. She now continues on a regular two-monthly clinical examination and CT scanning. Read the full case report here.

Case reports and the bid to improve patient care

Sharing reports of side-effects and unusual disease progression is becoming easier  – much of this can be put down to the Open Access model of publishing which allows free information to all. Dr Gurjal adds, “Case reports provide a medium for discussion of possible adverse drug reactions, mechanisms for the adverse reactions and possible prevention steps in the future. This facility is not available through other reporting channels. Journal of Medical Case Reports being an online journal with open access allows rapid dissemination of important information to healthcare professionals around the world. Benefits to patient care can be translated very quickly.”

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