Oh, bev.

A recurring issue with radiation is a lack of data on potential pharma interactions, especially in the metastatic setting. The big fear of doing lung SBRT with concurrent bevacizumab is the risk of serious airway hemorrhage. When might you encounter this scenario? First could be in patients with metastatic non-squamous lung cancer whose medical oncologist could make sense of IMpower150. Second could be in patients with lung mets from colorectal cancer. Another big question relates to timing. Biologics have long half-lives, so it’s not so easy to just stop for a week, treat, and restart. Do we have any great data to throw out here? No. But at least you can get a sense of the community feel for this scenario. TBL: When considering lung SBRT in patients with recent bevacizumab exposure, use good clinical judgement and be particularly wary of central or ultracentral targets. | theMedNet 2019