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June 8, 2011

Bevacizumab and Cancer Treatment-Related Mortality

Author Affiliations

Author Affiliations: Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (Dr Punt) (c.punt@onco.umcn.nl); Trials Office, Comprehensive Cancer Centre The Netherlands, Nijmegen (Ms Mol); and Department of Medical Oncology, University Medical Centre, Utrecht, the Netherlands (Dr Koopman).

JAMA. 2011;305(22):2291-2293. doi:10.1001/jama.2011.758

To the Editor: Dr Ranpura and colleagues performed a meta-analysis on treatment-related mortality with bevacizumab in cancer patients.1 The authors referred to results of our research that showed a higher overall risk of FAEs in cancer patients due to serious toxic effects of chemotherapy.2 We monitored FAEs in a study of 820 patients with metastatic colorectal cancer.3 One of our main findings, after reviewing individual records of patients experiencing FAEs, was a difference in the assessment of the relationship between FAEs and treatment between treating physicians and an independent data monitoring committee in 65% of patients. Furthermore, we found that major protocol violations were involved in the majority of FAEs, which implies that these FAEs could have been prevented by more adequate patient care. Therefore, we ask the authors whether such monitoring was performed on the FAEs in the studies included in their meta-analysis. This would allow a better assessment of the possible relationship of FAEs with bevacizumab treatment and would provide insights into whether certain FAEs could have been prevented by better adherence to treatment guidelines.

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