Cancer-Associated Thrombosis on Bevacizumab: Risk of Recurrence and Bleeding When Bevacizumab Is Stopped or Continued

SIMPLE SUMMARY: Cancer-associated thrombosis is a frequent complication and a poor prognostic event. Bevacizumab is an antiangiogenic drug used in the treatment of many cancers. Few data are available on the concomitant use of bevacizumab and anticoagulant therapy. The aim of this retrospective multicenter study was to determine the safety and efficacy of anticoagulant therapy in patients receiving bevacizumab. We observed that patients with a cancer-associated thrombosis on bevacizumab did not experience more bleeding complications or thromboembolic recurrences on anticoagulant therapy if they continued bevacizumab. The safety and efficacy of anticoagulant therapy did not appear to be affected by bevacizumab, and these results encourage clinicians to continue this drug. ABSTRACT: Cancer-associated thrombosis (CAT) is a common complication during cancer, with complex management due to an increased risk of both recurrence and bleeding. Bevacizumab is an effective anti-angiogenic treatment but increases the risk of bleeding and potentially the risk of venous thromboembolism (VTE). The aim of this study was to evaluate the efficacy and safety of anticoagulant therapy in patients with CAT receiving bevacizumab, according to the continuation or discontinuation of bevacizumab. In a retrospective multicenter study, patients receiving anticoagulant for CAT occurring under bevacizumab therapy were included. The primary endpoint combined recurrent VTE and/or major or clinically relevant non-major bleeding. Among the 162 patients included, bevacizumab was discontinued in 70 (43.2%) patients and continued in 92 (56.8%) patients. After a median follow-up of 318 days, 21 (30.0%) patients in the discontinuation group experienced VTE recurrence or major or clinically relevant non-major bleeding, compared to 27 (29.3%) in the continuation group. The analysis of survival following the first event showed no significant difference between the groups in uni- or multivariate analysis (p = 0.19). The primary endpoint was not influenced by the duration of bevacizumab exposure. These results suggest that the efficacy and safety of anticoagulant therapy in patients with CAT receiving bevacizumab is not modified regardless of whether bevacizumab is continued or discontinued.