Bevacizumab before cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis of colorectal origin: Analysis of early postoperative complication rate and long term follow-up.

Abstract

3642 Background: Patients with stage IV colorectal cancer and peritoneal carcinomatosis are increasingly treated with curative intent and perioperative systemic chemotherapy combined with targeted therapy.The aim of the study was to analyze the potential impact of bevacizumab on early morbidity and survival after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal carcinomatosis of colorectal origin. Methods: From 2004 to 2010, in three referral centers, 182 patients with colorectal carcinomatosis were treated with complete cytoreduction followed by HIPEC after either preoperative systemic chemotherapy alone or in combination with bevacizumab. Because there was no control on treatment allocation, propensity score methods were used to control this bias. Results: The median time from discontinuation of bevacizumab to HIPEC was 7 weeks (range, 6-10). Major morbidity was greater in the Beva group (34 vs. 19%, p=0.020). Nine patients died postoperatively: 5 (6.2%) in the Beva group (n=80) and 4 (3.9%) in the group treated with chemotherapy alone (n=102) (p=NS). The rate of digestive fistulas was greater in the Beva group, although not significant (18 vs. 10%, p=NS). After matching, the effect of Bevacizumab on major morbidity (including death) was found to be significant (OR = 2.28, 95% CI; 1.05 - 4.95) (p=0.04). No difference in median of overall and disease free survival was found between the two groups (12 and 36 month in Beva group vs. 14.3 and 49 month in the control group, p=NS). Conclusions: Administration of bevacizumab before surgery with complete cytoreduction followed by HIPEC for colorectal carcinomatosis is associated with 2-fold increased morbidity. The oncologic benefit of bevacizumab before HIPEC remains to be evaluated with prospective randomized study.