Bowel perforation in non-small cell lung cancer after bevacizumab therapy

Invest New Drugs. 2009 Apr;27(2):184-7. doi: 10.1007/s10637-008-9162-z. Epub 2008 Jul 30.


Background: Bevacizumab is increasingly used in combination with chemotherapy for treatment of unresectable non-small cell lung cancer. The aim of this report is to underline possible risks associated with this otherwise well-tolerated drug.

Patient: A 69-year-old patient with metastatic non-small cell lung cancer was started on a palliative chemotherapy regimen containing carboplatin, paclitaxel, and bevacizumab.

Results: After the second cycle of chemotherapy, the patient developed abdominal pain. On emergency laparotomy, there was diffuse perforation of the colonic wall, so the patient underwent a Hartmann's procedure with subtotal colectomy. Histopathological examination confirmed the diagnosis of ischemic colitis.

Conclusion: Gastrointestinal perforation is a known adverse event of bevacizumab therapy which so far has occurred only in patients with predisposing risk factors. Our patient illustrates that there must always remain a high index of suspicion regarding bowel perforation in patients developing acute abdominal pain under bevacizumab therapy, even if they have no apparent risk factors.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / administration & dosage
  • Angiogenesis Inhibitors / adverse effects*
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bevacizumab
  • Carboplatin / administration & dosage
  • Carboplatin / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / complications*
  • Carcinoma, Non-Small-Cell Lung / drug therapy
  • Humans
  • Intestinal Perforation / chemically induced*
  • Lung Neoplasms / complications*
  • Lung Neoplasms / drug therapy
  • Male
  • Paclitaxel / administration & dosage
  • Paclitaxel / therapeutic use


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Bevacizumab
  • Carboplatin
  • Paclitaxel