Evaluation of safety of bevacizumab as second-line treatment of patients with metastatic colorectal cancer.

PURPOSE: Bevacizumab is a relatively new monoclonal antibody introduced in the treatment of metastatic colorectal cancer (CRC). Since varied efficiency and adverse events of this drug were reported, the purpose of this study was to assess the safety of bevacizumab as second-line treatment of patients with metastatic CRC. METHODS: This observational, non-interventional study involved 35 patients with metastatic CRC treated with bevacizumab. Patients were from the Oncology Clinic, Clinical Centre of Montenegro. Monitoring of patients was done according to the study protocol. RESULTS: The number of subjects with abnormal values of tumor marker CEA has decreased from 56.8% (enrollment visit) to 50% in the sixth visit (p<0.01). The number of subjects with abnormal values for tumor marker Ca19-9 ranged from initial 45% (enrollment visit) to 50% on the sixth visit (p>0.05). No significant differences in the average values of hematological and biochemical parameters and the average values of the CEA and Ca19-9 were noticed. In 26 (46.2%) patients, adverse events were recorded. Of 72 adverse events, 31 (43.05%) were related to bevacizumab. Regarding adverse events intensity, 68.1% were moderate. The most common adverse event was hypertension, which was recorded in 12 patients. There was no life-threatening adverse event connected with the drug use. CONCLUSION: Use of bevacizumab caused moderate adverse effects, none of which was life-threatening.

An international survey of practice patterns and difficulties in cancer pain management in Southeastern Europe: a Turkish & Balkan Oncology Group common initiative.

PURPOSE: While pain is highly prevalent in cancer patients and its management is universally challenging, it is more commonly undertreated in the developing world. Southeastern European countries have limited resources and manpower to allocate for delivery of effective care for cancer-related pain. The purpose of this study was to explore the practice methods and the barriers to effective pain management in Southeastern Europe. METHODS: We conducted a Web-based survey using a specially designed questionnaire among physicians practicing in member countries of the Balkan Union of Oncology (BUON). RESULTS: A representative from each of the member countries of BUON (including Armenia and Georgia) and close to 100 physicians from 8 countries responded. The majority (89%) of respondents were medical oncologists and had been practising for 10 years on average. For pain assessment, only 35.4% of the physicians used a formal pain scale. Of the respondents 34.1% were not able to reach the optimal doses of narcotic medications while managing cancer pain, mostly due to concerns about toxicity, such as constipation and nausea. Most physicians listed their inability to consult sub-specialists to seek assistance for improving pain management cases as one of the major difficulties in day-to- day clinical practice, along with lack of time. CONCLUSIONS: The limitations faced by our respondents seem to be related mostly to the shortcomings of the respective health care systems, along with the need for more experience and knowledge about the titration of pain medications and dealing with toxicities.