Bevacizumab Does Not Influence the Efficacy of Partial Splenic Embolization in the Management of Chemotherapy-Induced Hypersplenism

Clin Colorectal Cancer. 2020 Dec;19(4):e189-e199. doi: 10.1016/j.clcc.2020.04.007. Epub 2020 Jun 12.


Background: Antiangiogenics attenuate chemotherapy-related hepatotoxicity and portal hypertension. The potential impact of bevacizumab on the efficacy and safety of partial splenic embolization (PSE) in the management of chemotherapy-induced hypersplenism (CIH) has never been investigated.

Patients and methods: We conducted a retrospective study with gastrointestinal cancer patients who have undergone PSE for the treatment of thrombocytopenia resulting from hypersplenism. Pre- and post-PSE platelet count (PC), the percentage of patients who resumed systemic therapy, and complication rates were compared between patients exposed and not exposed to bevacizumab.

Results: A total of 110 patients were eligible. Colorectal cancer was the predominant neoplasm (60%), and 5-fluorouracil, oxaliplatin, and bevacizumab were the most commonly provided drugs (70%, 65%, and 65% of patients, respectively). After PSE, 80% of patients recovered PC ≥ 100 × 109/L (100K). Systemic therapy was resumed in 81% of patients. Seventy-one patients exposed to bevacizumab had a median PC before PSE of 77.5K and after PSE of 167.0K, with a mean difference of 108K (P < .0001). Thirty-nine patients not exposed to bevacizumab had a median PC of pre-PSE of 73.0K and post-PSE of 187.0K, with a mean difference of 117.7K (P < .0001). Both groups had similar values of percentages of patients with PC post-PSE ≥ 100K (83% vs. 74%; P = .463), resumption of systemic therapy (85% vs. 74%; P = .213), and complication rates. A linear association between splenic infarction rate and increment in PC was found (P < .0001).

Conclusion: PSE is a safe and effective procedure in the management of CIH, regardless of the provision of bevacizumab. Splenic infarction rate should be optimized to enhance patient outcomes.

Keywords: Chemical- and drug-induced liver injury; Drug-related side effects and adverse reactions; Oxaliplatin; Therapeutic embolization; Thrombocytopenia.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Agents / adverse effects*
  • Bevacizumab / administration & dosage*
  • Child
  • Combined Modality Therapy / methods
  • Embolization, Therapeutic / adverse effects*
  • Embolization, Therapeutic / methods
  • Embolization, Therapeutic / statistics & numerical data
  • Female
  • Gastrointestinal Neoplasms / drug therapy
  • Humans
  • Hypersplenism / blood
  • Hypersplenism / chemically induced
  • Hypersplenism / therapy*
  • Male
  • Middle Aged
  • Platelet Count
  • Retrospective Studies
  • Spleen / blood supply
  • Spleen / drug effects
  • Splenic Infarction / epidemiology*
  • Splenic Infarction / etiology
  • Splenic Infarction / prevention & control
  • Treatment Outcome
  • Young Adult


  • Antineoplastic Agents
  • Bevacizumab