Researchers Recommend Having Port in Place for Week Before Starting Avastin

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A study found that women diagnosed with metastatic breast cancer who got Avastin (chemical name: bevacizumab) within 1 week of having a venous access line (also called a central line, in-dwelling venous catheter, or port) put in had a high risk of developing wound complications. These complications included breakdown of tissue around the catheter (wound dehiscence), dying skin cells, and infection. A venous access line is used to give chemotherapy and other intravenous treatments.

Based on these results, the researchers recommend waiting until a venous access line is in place for 1 week before giving Avastin. These results were presented at the 2010 San Antonio Breast Cancer Symposium (SABCS).

The targeted therapy Avastin is currently approved by the U.S. Food and Drug Administration (FDA) to be used in combination with Taxol (chemical name: paclitaxel) to treat metastatic, HER2-negative breast cancer that hasn't already been treated with chemotherapy. Metastatic breast cancer is cancer that has spread outside the breast to another part of the body. Avastin works by blocking the growth of new blood vessels that cancer cells need to grow and function. A protein called vascular endothelial growth factor (VEGF) makes new blood vessels grow in cancer cells. Avastin blocks the VEGF protein. Avastin is given intravenously.

In December 2010, the FDA recommended removing the breast cancer indication for Avastin because newer research results suggest that the benefits of Avastin don't outweigh the risks. This decision is being appealed by the company that makes Avastin.

Doctors know that Avastin can make it difficult for tissue to heal after surgery, though the reason for this isn't clear. After a dose is given, Avastin takes 2 to 3 weeks to clear the body. So women who get Avastin before surgery usually don't have surgery until 2 or 3 weeks after the last dose of Avastin was given. Placing a venous access line is a minor surgical procedure and researchers wanted to know if women who got Avastin within a week of venous access line placement would have wound complications.

The researchers reviewed the records of more than 4,300 women being treated for metastatic breast cancer who had venous access lines placed to give intravenous treatments, such as chemotherapy and Avastin. They found that 8.6% of women who got Avastin within 1 week of venous access line placement had serious wound problems at the access line site. Less than 1% (0.19%) of women who didn't get Avastin had wound problems.

Twelve women had skin breakdown at the site of the venous access line after getting Avastin within one week of line placement. Six of these women had to stop getting Avastin due to the severity of the side effect. Doctors also were concerned that continuing on Avastin might worsen the wound problems or prevent healing.

Experts believe that women who will be getting chemotherapy and Avastin as part of their treatment plan should wait to get the first Avastin dose until 1 week after a venous access line is put in, or longer if the wound from the venous access line hasn't healed. It's OK to get chemotherapy sooner.

If Avastin is part of your treatment plan and you'll be having surgery or a venous access line put in, it's a good idea to talk to your doctor about this study.

You can learn more about Avastin in the Breastcancer.org Targeted Therapies section of Breastcancer.org.

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