History of PE, now on daily Arixtra: Avastin too risky? - 1259770

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History of PE, now on daily Arixtra: Avastin too risky? - 1259770

Hello, and thanks so much for this website. I only wish you had a gyn onc on your staff, as I know you demure on questions related to endometrial cancer. This, however, is more of a drug question, so perhaps you would be willing to tackle it.

My friend was diagnosed with stage IVB endometrial cancer 16 months ago; she had a "suboptimal" hysterectomy and omentectomy, 6 sessions of taxol/carboplatin (did not achieve a remission), followed by a regimen of alternating tamoxifen and Megace, during the course of which she developed a saddle pulmonary embolism 5 months ago. She has recovered from that pretty well, but she has progressive disease, with growing tumors in her abdomen and spleen and the new addition of a possible pleural metastasis. (She had a 2.5 cm mediastinal mass at diagnosis, which has not changed in size.)

Dr. Gray at SCCA in Seattle, whom my friend saw in consultation last March (pre-PE) recommended that when the hormonal therapy quit working, my friend should next have Avastin (followed by Gemzar or Topotecan if the Avastin did not work or quit working). She has now progressed on the hormone therapy, so it is time for the next step, but my friend is afraid to go on the Avastin--given its reputation for causing life-threatening bowel perforations and increased risk of bleeding--now that she has had a pulmonary embolism and is therefore on daily Arixtra shots.

I have 2 questions: (1) Does a history of PE increase the danger of serious side effects while on Avastin? and, (2) While her doctor says that being on Arixtra and Avastin at the same time does not increase bleeding risk, I am wondering if a LMWH (eg., enoxaparin) would be a "safer" alternative, since its half-life is shorter (and differs in other ways) from fondaparinux.

Thanks so much, once again, for this site, and for any responses to my questions.


Dr West
Reply To: History of PE, now on daily Arixtra: Avastin too risky

People who have a history of pulmonary emboli have often been excluded from clinical trials with Avastin (bevacizumab) due to concern of an increased risk of bleeding (from the blood thinners) or clotting, both of which seen more commonly in patients on Avastin. To my knowledge, there is not enough known about safety of Avastin in people on various anti-coagulants with ovarian cancer to say anything authoritatively, so it comes down to a matter of judgment.

Good luck.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education