Bevacizumab 為一種抑制血管新生的單株抗體，是第一個獲得美國FDA 核准與常規化學治療合併使用作為轉移性大腸直腸癌治療之藥物，以大幅提高大腸直腸癌治療效果並延長病人存活期。一般而言，bevacizumab發生之副作用大多為病人可以忍受，但出血、血栓與胃腸穿孔等嚴重副作用，發生率雖低卻有著極高之致死率。

本文即為探討一位76 歲的男性病人因轉移性降結腸惡性腫瘤，接受兩次bevacizumab 合併FOLFIRI 治療後，發生劇烈腹痛經電腦斷層掃描顯示為臟器穿孔導致之氣腹及腹膜炎，於緊急手術切除小腸穿孔部位，經術後持續照顧及休養後已逐漸好轉。
本文藉由文獻回顧，探討bevacizumab 造成胃腸穿孔之機轉、進程及治療，醫療專業人員對藥物不良反應之確實通報更有極大之重要性，而藥師於審核處方時，更不能忽略病人曾發生之藥物不良反應。因此，落實藥物不良反應之通報並藉由醫囑系統給予提示，除利於其客觀評估、分析與回饋，更可進一步提醒、預防及減輕不良反應對病人造成的危害。
 

Bevacizumab was the first anti-angiogenesis monoclonal antibody approved by the US Food and Drug Administration (FDA) indicated for metastatic colorectal cancer in combination with standard chemotherapy,was found higher response rate to increase both overall and progression-free survival, when compared with standard chemotherapy plus placebo. In general, the toxicity profile of bevacizumab is acceptable and well tolerated by the patients. Some of the adverse effects like bleeding, thromboembolic events and gastrointestinal perforation are rare but life-threatening.
A 76-year-old man with metastatic descending colon cancer was treated in palliative chemotherapy with bevacizumab, irinotecan, fluorouracil and leucovorin regimen and he developed severe abdominal pain after two courses of the palliative chemotherapy. The abdominal Computerized tomographic scans revealed bowel perforation with pneumoperitoneum and peritonitis. An emergent surgery with resection of small bowel with anastomosis and enterolysis was performed and he recovered within a few weeks after the emergent surgery.
In this report, we use the method of literature review to discuss about the mechanisms, progression and the managements of bevacizumab-induced-gastrointestinal perforation. The awareness of reporting adverse drug reactions (ADR) is important. Pharmacists should pay attention to the adverse drug reactions potentially occur on the patient during reviewing medication profile. Using ADR reporting system and computer alerts can help healthcare providers to review, evaluate and feedback about the ADR effectively, in order to prevent further damage to the patient.