A 60-year-old man with metastatic colorectal carcinoma receiving bevacizumab is scheduled for elective resection of his primary tumour in three weeks. The surgeon asks whether the drug should be withheld. The main reason for stopping bevacizumab before surgery is:

• A Severe hypersensitivity reactions to the mouse-derived Fab portion
• B Profound immunosuppression increasing postoperative sepsis
• C Cumulative irreversible cardiomyopathy requiring cardiac clearance
• D Impaired angiogenesis causing delayed wound healing and dehiscence ✓

Explanation

Bevacizumab blocks VEGF, and VEGF is required for granulation tissue formation and wound repair. Surgery within roughly four to six weeks of a dose carries increased risk of wound dehiscence, bleeding and gastrointestinal perforation, so the drug is held around operations. Hypertension and proteinuria are its chronic toxicities but are not the perioperative concern. It is not meaningfully immunosuppressive and does not cause cumulative cardiomyopathy.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.