Targeted therapies and surgical issues in gastrointestinal cancers

Targeted therapies in combination with traditional cytotoxic chemotherapy have revolutionized the treatment of many gastrointestinal malignancies. Although well tolerated in general, they are also associated with unique toxicities and perioperative issues. Anti-vascular endothelial growth factor (VEGF) therapy is the best studied and most widely used targeted strategy in the treatment of GI maligancies. Bevacizumab (BV) is the most widely used agent and is unique in its long half-life. Wound complications as well as gastrointestinal perforations appear to be higher in patients who undergo surgical procedures while receiving BV, although it remains unclear as to when to stop BV prior to surgery. The use of BV prior to hepatic resection, however, is safe and does not lead to an increase in morbidity or mortality. Other approved VEGF agents have been less studied, but do not appear to lead to increased complications. Other biologic agents including those targeting the epidermal growth factor receptor (EGFR) pathway and others also do not appear to be associated with an increase in perioperative complications.