SESSION TITLE: Lung Cancer SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Bevacizumab is a recombinant IgG1 antibody to VEGF currently approved for use in advanced non-small cell lung cancer. Phase III trials have demonstrated that bevacizumab addition to antineoplastic regimens have improved survival in this patient population. Bevacizumab causes microvascular involution in tumors and suppression of tumor angiogenesis. There are many recorded sinopulmonary toxicities such as pulmonary hemorrhage, venous thromboembolism, and nasal septal perforation. Here we report bronchial perforation in the setting of advanced pulmonary adenocarcinoma. CASE PRESENTATION: Our patient is a 56 year old male with a 30 pack-year smoking history who initially presented to the pulmonary clinic with wheezing, cough and shortness of breath. Imaging at the time showed a right supra hilar mass and right upper lobe collapse. Bronchoscopy with endobronchial ultrasound (EBUS) was performed with subsequent pathology showing poorly differentiated adenocarcinoma (EGFR negative, ALK-EML4 negative, ROS1 negative); left adrenal biopsy confirmed metastasis. His treatment consisted of cisplatin and pemetrexed every three weeks for four total cycles with complete adrenal and partial pulmonary response. Following this treatment, he underwent six weeks of low dose carboplatin and paclitaxel with concurrent thoracic radiation, followed by three weeks of maintenance pemetrexed. He suffered from recurrent post-obstructive pneumonias due to his chronic RUL obstruction and the obstruction unfortunately was not amenable to endobronchial intervention. He also developed pneumonitis after multiple rounds of radiation and a right-sided para malignant pleural effusion. Video-assisted thoracoscopic surgery and indwelling pleural catheter placement by thoracic surgery was performed. Carboplatin and paclitaxel with the addition of bevacizumab every three weeks for six cycles was then started followed by maintenance bevacizumab. He presented with hemoptysis 15 months after starting bevacizumab. Bronchoscopy was performed, revealing loss of the integrity of the bronchial wall of the right bronchus intermedius with tissue protruding through the bronchial wall. It was recommended at that time to discontinue bevacizumab DISCUSSION: To our knowledge, this is the only case in the current literature of bronchial perforation secondary to bevacizumab. Literature review predominantly revealed nasal perforation as the most common sinopulmonary complication from bevacizumab treatment with pulmonary hemorrhage being a close second. In our case, the patient was on bevacizumab 15 mg/kg every 3 weeks for 6 total cycles and then maintenance dose for 37 total cycles (15 total months). His treatment had to be stopped given the extent of the perforation. CONCLUSIONS: Bevacizumab toxicity is well reported in the upper airway. Our case is one of pulmonary involvement most likely due to a vascular mediated effect causing airway necrosis Reference #1: Keating, Gillian M. “Bevacizumab: A Review of Its Use in Advanced Cancer.” Drugs, vol. 74, no. 16, 2014, pp. 1891–1925. Reference #2: Higa, Gerald M, and Jame Abraham. “Biological Mechanisms of Bevacizumab-Associated Adverse Events.” Expert Review of Anticancer Therapy, vol. 9, no. 7, 2009, pp. 999–1007. Reference #3: Vahid, Bobbak, and Paul E. Marik. “Pulmonary Complications of Novel Antineoplastic Agents for Solid Tumors.” Chest, vol. 133, no. 2, 2008, pp. 528–538. DISCLOSURES: No relevant relationships by Chhaya Patel, source=Web Response No relevant relationships by Juan Sanchez, source=Web Response