February 01, 2010 Investigational New Drugs The Journal of New Anticancer Agents Editor-in-Chief, Eric K. Rowinsky Attn: Laura.Walsh laura.walsh@springer.com Ann Salvador anna.salvador@springer.com Re: A short report on article by V. Pruliere-Escabasse et al., Vol. 27: 285–286, 2009 Dear Editor, I have recently read the article on “Rhinitis and epistaxis in patients treated with antiangiogenic therapy.” I take exception to their conclusion. I have used bevacizumab, a VEGF inhibitor successfully in patients with HHT epistaxis. In the first report [1] the bevacizumab was injected and in the second report [2] the bevacizumab was sprayed. In both applications the bevacizumab was used in low concentrations namely 50–100 mgs and not in cancer doses such as 5–10 mgs per kilograms IV q 2 weeks. In both papers we report resolution of HHT related epistaxis. In no cases did we see crusting or atrophic rhinitis. I strongly suspect that whatever nasal changes were seen, may or may not be related to the patient’s disease or the therapy, but if indeed it was, I would be more suspect about the combination chemotherapy then I would about the VEGF inhibitors. As VEGF inhibitors play an important role in the treatment of a number of nasal conditions, this report of an adverse event must be taken with great caution. Sincerely, Terence M. Davidson, M.D., FACS Professor of Surgery Division of Otolaryngology-Head and Neck Surgery Associate Dean for UCSD Continuing Medical Education Section Chief, VA Head and Neck Surgery TMD:bas