Zentralbl Chir 2019; 144(S 01): S64-S65
DOI: 10.1055/s-0039-1694118
Vorträge – DACH-Jahrestagung: nummerisch aufsteigend sortiert
Georg Thieme Verlag KG Stuttgart · New York

Bevacizumab as triple induction chemotherapy does not increase bleeding complications during mesothelioma surgery

O Lauk
1   Department of Thoracic Surgery, University Hospital Zurich, Switzerland
,
K Bruestle
1   Department of Thoracic Surgery, University Hospital Zurich, Switzerland
,
M Friess
1   Department of Thoracic Surgery, University Hospital Zurich, Switzerland
,
TDL Nguyen
2   Department of Radiology, University Hospital Zurich, Switzerland
,
T Frauenfelder
2   Department of Radiology, University Hospital Zurich, Switzerland
,
A Curioni-Fontecedro
3   Department of Oncology, University Hospital Zurich, Switzerland
,
W Weder
1   Department of Thoracic Surgery, University Hospital Zurich, Switzerland
,
I Opitz
1   Department of Thoracic Surgery, University Hospital Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

Publication Date:
04 September 2019 (online)

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Background:

Adding anti-angiogenic Vascular Endothelial Growth Factor (VEGF) inhibitor bevacizumab to doublet cisplatin/pemetrexed (cis/pem) in 2nd line treatment for malignant pleural mesothelioma was reported to have a significant improvement on overall survival in a phase III trial by Zalcman et al. However, increased high grade bleeding after operation was reported. In the present analysis, we report on intra- and postoperative bleeding risk when bevacizumab (avastin) was used as induction therapy prior to surgery for mesothelioma.

Material and method:

227 malignant pleural mesothelioma (MPM) patients intended to be treated at the University Hospital of Zurich between 2002 and December 2018. 25 patients were treated with 3 to 6 cycles of induction chemotherapy with cis/pem and bevacizumab whereas the last cycle prior to surgery was conducted without bevacizumab. These 25 patients were compared with a historical cohort undergoing doublet induction chemotherapy with cis/pem alone. The use of erythrocytes until postoperative day (POD) 14 was analyzed. Tumor response to induction chemotherapy was assessed by modified response criteria in solid tumors (mRECIST) in a restaging CT scan.

Result:

According to mRECIST criteria, nine patients presented with partial remission (PR) and 16 patients showed a stable disease (SD) after triplet chemotherapy compared to 50 with PR, 87 with SD and 29 with progressive disease (PD) in the historical cohort. There was a significant difference between both groups (p = 0.043). The median intraoperative blood loss in the bevacizumab group was 600 ml and in the historical group 700 ml. The intraoperatively applied erythrocyte concentrates in the bevacizumab group was six compared to 64 in our historical control (p = 0.64) and in the postoperative phase three compared to 12, respectively.

Conclusion:

These initial data demonstrate that macroscopic complete resection can be performed safely after induction chemotherapy with the addition of bevacizumab. Tumor response rates were significantly better when adding bevacizumab.