bevacizumab and radiation

[Burt Radnolds]

I work with a medical oncologist who is in love with Avastin. He constantly sends me patients actively getting the drug, requesting different forms of radiation, sometimes including SBRT. I have seen some cautionary tales, especially regarding GI toxicity (esophagus, bowel, etc).

Was wondering how people are dealing with this? Also, thoughts on same question with Tarceva?

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[medgator]

ummmm I don't treat pts who received avastin within the last 3 weeks, personally. If this med onc is avastin happy, I'd consider sitting down and talking with him/her about the concerns of concurrent treatment and possible toxicity preferably with some of the data that's been accumulated on the issue.

 

[Burt Radnolds]

They are mostly lung cancer patients and he is dosing on a 21 day cycle. I usually advocate to skip one cycle to give several weeks of "wash out", then treat, then he can resume on the next scheduled cycle.

Thanks for your response, was interested in getting as many opinions as possible as there don't seem to be any firm recommendations on it that I've seen at least.

 

[medgator]

They are mostly lung cancer patients and he is dosing on a 21 day cycle. I usually advocate to skip one cycle to give several weeks of "wash out", then treat, then he can resume on the next scheduled cycle.

Thanks for your response, was interested in getting as many opinions as possible as there don't seem to be any firm recommendations on it that I've seen at least.

Probably not a big concern theoretically if you were treating peripheral lung with SBRT or external away from the mediastinum, but personally I woudn't chance it

 

[napoleondynamite]

I'm afraid enough to refuse to treat unless they've been off it for 2-3 weeks..I wouldn't feel comfortable personally doing SBRT concurrent

 

[seper]

just discussed that... for central lung targets (black box warning), I wait for 6 weeks.

 

[Burt Radnolds]

Sorry, missed the conversation below, just read it. Any thoughts on liver SBRT? Thoughts on how long before restarting the drug?

 

[Gfunk6]

SBRT Liver and Avastin are a potentially dangerous combination . . .

http://www.redjournal.org/article/S0360-3016(13)00544-0/abstract

 

[radiaterMike]

SBRT Liver and Avastin are a potentially dangerous combination . . .

http://www.redjournal.org/article/S0360-3016(13)00544-0/abstract

Surprised that this wasn't published in nejm.

 

[seper]

sarcasm?

 

[radiaterMike]

sarcasm?

Often find 'anti' rt articles in nejm. As this is avastin + rt I guess it doesn't qualify.