Oncology Drugs With an Impact on IR Procedures

Nadine Abi-Jaoudeh, MD, University of California, Irvine, goes over the oncology drugs that may have an impact on interventional radiology procedures. Dr Abi-Jaoudeh focuses on VEGF inhibitors, which can affect the vasculature, immune checkpoint inhibitors, and certain chemotherapies, which can result in liver toxicities. She also highlights semaglutide, or Ozempic, which can delay gastric emptying and lead to aspiration if a patient is on general anesthesia or moderate sedation.

Transcript:

Hi, Nadine Abi-Jaoudeh, Section Chief of Interventional Radiology at the University of California. Irvine, I'm here at CIO, and I'm going to mention to you about drugs to watch out for in interventional oncology, and especially oncology drugs specifically.

Easier to say is every drug can have side effects, complications, etc, but really the ones to watch out for is any anti-VEGF inhibitors, and specifically, bevacizumab (Avastin). The reason why we pick on Avastin a little bit more than the others is because it's half-life is so long. And so therefore, you really should be very careful in terms of, if you're doing a port even, the healing will not be the same as if they're not on Avastin. As well as, if you're doing anything intra-arterial, there's a higher risk of dissections, higher risk of thrombosis.

And it's really dose-dependent. If they just started on it, you might not get into trouble, but if they've been on it for a while, there's going to be a change one in the vasculature, it's going to be diminutive, it's going to tear easily on you, and there's also going to be a change in the flow. In fact, one of the papers a while back showed that one of the risk factors for reflux with Y90 resin beads was patients that were on Avastin. I really recommend stopping at anywhere between 4 to 6 weeks. But any anti-VEGF inhibitor is exactly the same thing — it's just most of them have a shorter half-life, so you don't have to stop it for as long.

You should watch out for immune checkpoint inhibitors. A lot of people think they're benign and they are. When you look at even the talks that were given this morning in the basic science session, they were talking about the fact that you get about 30% grade 3/4 adverse events with immune checkpoint inhibitors versus 80% with chemotherapy. They are a lot more benign than the chemotherapies, but they still have effects. And when they do, those effects tend to be very dramatic. Watch out for liver toxicity.
The other ones to really watch out for is patients that were on any carboplatins, oxaloplatin, and irinotecan, in terms of liver toxicity. The liver looks normal, and people tell you, “Oh yeah, they're not cirrhotic.” But they do have some form of cirrhosis in a way, just because of that cumulative dose of chemotherapy they've gotten. In colorectal patients, just remember those drugs.

One other one is Ozempic [semaglutide], it's not an oncology drug, but most patients are on it, especially now HCC [hepatocellular carcinoma] patients, they're taking it like candies. And the Association of Anesthesia just put out a warning that it does delay gastric emptying. If you're putting your patients in general anesthesia or even moderate sedation, they are at a higher risk of aspiration compared to patients who are not on it. hey do recommend stopping it for a week, I believe.

You'll usually see these drugs as you get a referral for procedures. I say biopsies are just fine, but any ports, where you're having an incision, or any of the more advanced like ablations, embolizations, any type, those are the times where you really want to look and see what other drugs the patients are on.

We see a lot of our patients in clinic before, especially for the more advanced procedures. This is where this will come up. We'll review these drugs, we'll discuss it with them, tell them, " I need you to stop this drug that many days in advance." A lot of it, too, is communications with the oncologist. We coordinate the treatments. Ports are the ones where we really have given instructions very clearly to our staff, because we don't see those patients in clinic, because the idea is to get them in as fast as possible.