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?

Topics: Gastrointestinal Cancers • Medical Oncology • Colorectal Cancer

> 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.

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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...

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Medical Oncologist at St. Francis Hospital
Thanks

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