P0196 - Risk of Perforation in Patients With Colorectal Cancer and Metallic Stents Who Received Bevacizumab Compared to Stent Alone or Non-Bevacizumab Chemotherapy: A Systematic Review and Meta-Analysis

Kyaw Min Tun, DO¹, Banreet S. Dhindsa, MD², Smit Deliwala, MD³, Syed Mohsin Saghir, MD⁴, Daryl Ramai, MD, MSc⁵, Amaninder Dhaliwal, MD⁶, Ishfaq Bhat, MD², Douglas G. Adler, MD^7
1Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV; ²University of Nebraska Medical Center, Omaha, NE; ³Emory University School of Medicine, Atlanta, GA; ⁴Creighton University, Omaha, NE; ⁵University of Utah, Salt Lake City, UT; ⁶McLeod Health, Florence, SC; ⁷Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: Bevacizumab (BV) is a monoclonal antibody against vascular endothelial growth factor and is used to treat metastatic colorectal cancer (CRC). Although BV is an effective therapy for CRC and is generally well-tolerated, it can be associated with severe complications such as bowel perforation, gastrointestinal bleeding, or thromboembolism. Self-expanding metallic stents (SEMS) are used in obstructive CRC for palliative or preoperative purposes. There is a paucity of published literature on whether the risk of perforation is increased when chemotherapy - BV-based regimen in particular - is administered to patients with SEMS placement. We performed a systematic review and meta-analysis to determine whether BV-based chemotherapy is associated with higher risk of perforation in patients with SEMS.

Methods: A comprehensive literature search was performed from major databases from inception to May 2023. The primary outcome assessed was the risk of perforation in BV+SEMS patients. The secondary outcomes assessed were the risk of bleeding in SEMS patients and non-BV+SEMS patients compared to BV+SEMS cohort. Pooled estimates were calculated using a random-effects model with 95% confidence interval (CI). The statistical analysis was performed by using CMA v 3.0 software (BioStat, Englewood, NJ).

Results: There were 11 studies included, with BV+SEMS, SEMS only, and non-BV+SEMS therapies given in 293, 215, and 101 patients respectively. There were 9 retrospective cohort studies, 1 prospective cohort study, and 1 randomized controlled trial. Four studies were conducted in the US, 1 in Korean, and 2 each in Italy, Spain, and Canada. The mean age was 66.69±7.42 years. About 87.20% of patients had SEMS placed in the left colon, 4.89% in the transverse colon, and 7.93% in the right colon. The overall pooled rate of perforation in patients who received BV+SEMS was 18% (95% CI: 10.2%, 29.7%; p=0.00; I²=64) (Figure 1). The risk ratios for developing perforation in BV+SEMS group was 1.56 (95% CI: 0.70, 3.47; p=0.28; I²=0) when compared to SEMS alone group and was 3.52 (95% CI: 0.79, 15.62; p=0.1; I²=42.5) when compared to non-BV+SEMS group.

Discussion: BV appears to increase perforation in CRC patients with SEMS, and is associated with a higher risk of perforation than those who received SEMS alone or SEMS + non-BV chemotherapy. Further randomized controlled trials and comparative analyses are needed to validate the findings of our study.



Disclosures:


Kyaw Min Tun, DO¹, Banreet S. Dhindsa, MD², Smit Deliwala, MD³, Syed Mohsin Saghir, MD⁴, Daryl Ramai, MD, MSc⁵, Amaninder Dhaliwal, MD⁶, Ishfaq Bhat, MD², Douglas G. Adler, MD⁷. P0196 - Risk of Perforation in Patients With Colorectal Cancer and Metallic Stents Who Received Bevacizumab Compared to Stent Alone or Non-Bevacizumab Chemotherapy: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.