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To the Editor: Dr Nalluri and colleagues¹ studied the risk of VTE in patients treated with bevacizumab. The results of the meta-analysis suggested that overall risk for both all-grade and high-grade VTE was increased in patients treated with bevacizumab. The effect was found to be dose-independent. For individual cancer types, all-grade VTE risk was only significant for renal cell carcinoma; high-grade VTE risk was significantly increased only in patients with colorectal cancer.

Although the mechanism whereby the neoplasm might induce thrombosis is not clear, it appears likely that the tumor releases some substance into the circulatory system that directly or indirectly activates the coagulation system.² Venous thromboembolic disease and catheter-related thrombosis have been documented in patients receiving 5-fluorouracil.³ A number of studies support the hypothesis that this group of drugs damages the vascular network and endothelium. For example, Cwikiel et al⁴ showed that exposure to 5-fluorouracil was associated with severe . . . [Full Text of this Article]

Saadettin Kilickap, MD
skilickap@yahoo.com

Cagatay Arslan, MD
Department of Medical Oncology
Hacettepe University Institute of Oncology
Ankara, Turkey

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