大腸直腸癌病患接受bevacizumab治療 引起嚴重胃腸道出血之發生率與治療方式 Treatment and incidence of high-grade gastrointestinal bleeding in patients with colorectal cancer treated with bevacizumab Lee Ming-Yang1, Hung Tsui-Lian 2,Ko Mei-Shu 2, Chang Yu-Ju1 李明陽1, 洪翠蓮2, 柯美淑2, 張育茹1 1 Division of Medical Oncology, 2 Department of Nursing, Chia-Yi Christian Hospital 1嘉義基督教醫院血液腫瘤科, 2護理部 Purpose Bevacizumab is a active agent in treatment of metastatic colorectal cancer. High -grade gastrointestinal bleeding in one of fetal complication of bevacizumab. We retrospect analyzed the incidence of this rare complication in our hospital and reported our treatment experiences. Materials and Methods From July 2011 to February 2012, adult metastatic colorectal cancer patients received systemic chemotherapy at Chia-Yi Christian Hospital was included. High grade bleeding is defined as WHO bleeding grade 3 or above toxicity. Patient received bevacizumab contained chemotherapy with bleeding adverse effects were recorded and analyzed by medical charts review. Results A total of 32 patients with metastatic colorectal cancer received bevacizumab contained chemotherapy at our hospital and totally 190 cycle bevacizumab were given. Only one grade 3 gastrointestinal bleeding was found in a female who received pelvic irradiation previously. The incidence was 3.13% (the incidence in all cycles was 5.26/1000), which is slightly lower than other reports by Western population (3-5% overall, and 9% in patient received pelvic irradiation) . We also performed colon-scope examination for this case and found the ischemic pan-colitis with intractable oozing. The condition did not resolve through conservative care, however successfully treated by L-glutamine without surgical intervention. Conclusions We should take care about bevacizumab induced high grade gastrointestinal bleeding, especially in patient who have undergone pelvic irradiation. Fig. 1 Ulcerative lesion with bleeding after bevacizumab treatment Fig. 2 Improving of bleeding and ulcerative lesions after L-glutamine treatment