Safety and Efficacy of Bevacizumab in Cancer Patients with Inflammatory Bowel Disease

SIMPLE SUMMARY: In patients with inflammatory bowel disease, chronic inflammation is a risk factor for the development of digestive and nondigestive cancers. The treatment, as in patients without inflammatory bowel disease, is a combination of chemotherapy and targeted treatments, such as bevacizumab and more recently, immunotherapy. It is generally believed that the use of bevacizumab and chemotherapy could increase toxicity and lead to adverse events in this population. This study aims to evaluate the safety and efficacy of the combination of bevacizumab and chemotherapy in patients with quiescent or moderately active inflammatory bowel disease in various forms of cancer and by increasing the quality of patient care in this subgroup. ABSTRACT: Background: The safety of bevacizumab in combination with chemotherapy in patients with inflammatory bowel disease (IBD) and digestive and nondigestive cancers is poorly documented. Methods: We retrospectively evaluated patient records of all adult cancer patients with IBD at our institution from April 2007 to May 2016 with an update in November 2019. Results: Twenty-seven patients with a history of IBD (Crohn’s disease, n = 22; ulcerative colitis, n = 5) who were treated with bevacizumab and chemotherapy for metastatic solid tumors were identified. At the time of advanced cancer diagnosis, 18 patients had quiescent IBD, whereas 9 patients had moderately active IBD. Among those with moderately active IBD, five had received corticosteroids less than six months prior to cancer diagnosis and one had received infliximab. The treated cancers were colorectal cancer (n = 13), small bowel cancer (n = 4), non-small cell lung cancer (n = 3), breast cancer (n = 3), and other cancers (n = 4). Patients received bevacizumab in combination with chemotherapy and/or as maintenance for a median of 6.7 months. Grade 2 or higher bevacizumab-related complications were proteinuria in two patients and hypertension, diarrhea, rectal bleeding, and intestinal perforation in one patient each. No clinical IBD flares were observed during bevacizumab treatment. Conclusion: Bevacizumab combined with chemotherapy is safe in cancer patients with moderately active or quiescent IBD.