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Purpose: In breast cancer patients, Mailliez and others described that 5 of 70 patients (7%) developed a bevacizumab-induced nasal septal perforation. However, to date, no studies have reported such rates in colorectal cancer patients, who derive a survival advantage with this drug., Methods: This study examined the incidence of bevacizumab-induced, clinically symptomatic, otolaryngology specialist-confirmed nasal septal perforation among 100 patients who had been consecutively-treated for metastatic colorectal cancer., Results: The incidence of nasal septal perforation was 1% (95% confidence intervals: -0.95% to 2.95%). This single adverse event was successfully managed conservatively. Within the whole group, 94 had been treated with bevacizumab at 5 mg/kg every two weeks, except for four patients treated at higher doses. The median number of bevacizumab doses (range) was seven (1-96). Concomitant chemotherapy had been prescribed to all patients, consisting of oxaliplatin, 5-fluorouracil, leucovorin, as per one of the FOLFOX regimens (44 patients); irinotecan, 5-fluorouracil, leucovorin, as per the FOLFIRI regimen (13 patients); both these regimens and no other (five patients); or a different regimen (38 patients)., Conclusion: Nasal septal perforation from bevacizumab occurs infrequently among colorectal cancer patients.

A 52-year-old woman, with a metastatic breast cancer, presented with a nasal septum perforation while receiving a treatment combining paclitaxel and bevacizumab. This is the fifth reported case of nasal septum perforation probably related to an anti-angiogenic therapy. A literature review and a discussion concerning the different causes of nasal septum perforation were performed., (Copyright © 2010 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Objectives/hypothesis: Assess for complications of intranasal Bevacizumab application in patients with hereditary hemorrhagic telangiectasia (HHT)-associated epistaxis., Study Design: Retrospective chart review., Methods: In 58 patients presenting with recurrent HHT epistaxis, Bevacizumab was applied intranasally either as a submucosal injection or as a topical spray between October 2006 and June 2010. In many of the injected patients, the potassium titanyl phosphate (KTP) laser was used adjunctively for vessel photocoagulation. A phone interview was performed in July 2010 to assess for treatment complications., Results: Of the 58 treated patients 52 were contacted. Patient surveys were performed 1.5 to 46 months following their initial Bevacizumab treatment. Within the treatment population, five patients had sustained a septal perforation. Notably, these patients were treated early in the study period at which time the cartilaginous septum was often both injected and lasered. Subsequently, the treatment protocol was changed and the cartilaginous septum was neither lasered nor injected. After these changes were made no additional septal perforations were identified. No other adverse events were associated with intranasal Bevacizumab treatment., Conclusions: Bevacizumab applied as either a submucosal injection or as a topical nasal spray, with or without application of the KTP laser, is a safe treatment regimen. Still, when Bevacizumab injections are performed, the cartilaginous nasal septum should be avoided as patients may develop septal perforations., (Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.)

The use of targeted/biologic therapies is now commonplace in the treatment of malignant and non-malignant diseases. The novel mode of action of these drugs has resulted in unpredictable and in some cases unexpected side effects. Given the widespread use of bevacizumab and its distinct mode of action, it is important that oncologists report any unexpected adverse events that may be associated with the drug. Herein, we report three cases of spontaneous nasal septum perforation secondary to bevacizumab. We hypothesize an etiology for this rare event and reasons why it is reasonable to rechallenge the patient.

Background: Bevacizumab is an anti-vascular endothelial growth factor approved in association with paclitaxel or docetaxel as first line in patients (pts) with metastatic breast cancer. Rare cases of nasal septum perforations have been reported. We report our experience of nasal perforation in breast cancer pts receiving bevacizumab and chemotherapy either in the adjuvant or in the metastatic settings., Methods: Between 1 January and 31 December 2009, 70 pts received bevacizumab together with chemotherapy. All the pts who had received bevacizumab were referred to the ENT specialist. Symptoms potentially related were looked for. Side effects were graded according to CTCAE., Results: Five nasal septum perforations were diagnosed (5 out of 70; 7.14%). Bevacizumab dose was 15 mg kg(-1) 3 weekly. Three pts were metastatic. Bevacizumab was associated with docetaxel (100 mg m(-2) every 3 weeks) in two pts and with weekly paclitaxel in one. The last two pts received bevacizumab in combination with anthracyclin and then taxanes in the adjuvant setting. In these two cases, nasal septum perforation occurred at the time of docetaxel treatment., Conclusion: A high incidence of nasal septum perforation has been shown in pts with breast cancer receiving bevacizumab together with chemotherapy. Several mechanisms could be involved (mucositis, delayed tissue repair, antiangiogenic action of taxanes).

Otolaryngologists should be made aware of a newer cause of nasal septal perforations resulting from the more recent antiangiogenic therapy used to treat malignancies. This case describes a 52-year-old white woman who developed a spontaneous nasal septal perforation after given the antiangiogenic drug, bevacizumab, for metastatic ovarian cancer treatment. Bevacizumab is a recently developed monoclonal antibody against vascular endothelial growth factor receptor used to inhibit angiogenesis. The patient was ultimately treated with a nasal septal button with good symptom relief. This case documents the first report in the otolaryngology literature describing this new etiology for nasal septal perforations.

The list of bevacizumab's adverse effects continues to grow: the latest additions are reversible posterior leukoencephalopathy and perforation of the nasal septum.