Continuing Bevacizumab Around PIPAC: What an Early Safety Study Found
Somashekhar SP, Ashwin KR, Rohitkumar C, et al. “Evaluation of the safety profile of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients receiving uninterrupted bevacizumab-based systemic chemotherapy: A retrospective analysis from a high-volume tertiary centre.” Surgical Oncology Insight. 2026;3:100262.
Bevacizumab, also known by the brand name Avastin, is used with systemic chemotherapy to treat ovarian, colorectal, and other cancers. The medication blocks a protein involved in forming new blood vessels, but it may also increase the risk of bleeding, gastrointestinal perforation, and problems with wound healing. For these reasons, bevacizumab is frequently paused before and after major surgery.
But does the same precaution need to apply to pressurized intraperitoneal aerosol chemotherapy (PIPAC), a minimally invasive procedure performed through small laparoscopic incisions?
What the researchers studied
Researchers at a high-volume cancer center in India reviewed 202 PIPAC procedures performed in 111 patients with peritoneal metastases between January 2023 and May 2025. Most patients had ovarian cancer, although the study also included people with gastric, colorectal, appendiceal, endometrial, and other cancers.
The researchers compared:
98 PIPAC procedures performed while patients continued bevacizumab-based systemic treatment
104 PIPAC procedures performed while patients received systemic treatment without bevacizumab
Bevacizumab was not specifically held because of PIPAC. On average, patients received their last pre-procedure dose 19.5 days before PIPAC and resumed treatment 4.4 days afterward.
What the study found
Within 30 days of PIPAC:
Complications occurred after 5.1% of procedures involving bevacizumab.
Complications occurred after 9.6% of procedures without bevacizumab.
The difference was not statistically significant, meaning it could have occurred by chance.
No patients died within 30 days.
No bleeding, gastrointestinal perforation, or delayed wound healing was reported in either group.
An exploratory adjusted analysis also found no statistically significant association between bevacizumab and complications. However, the number of complications was small, making that analysis uncertain.
Although the complication rate was numerically lower in the bevacizumab group, the study does not show that bevacizumab reduces the risk of complications.
Why this research matters
Pausing bevacizumab for every PIPAC procedure could interrupt systemic treatment, particularly when PIPAC is repeated every four to six weeks. Because PIPAC generally involves small incisions and less tissue disruption than major abdominal surgery, the precautions used for larger operations may not apply in exactly the same way.
These findings suggest that continuing bevacizumab around PIPAC may be feasible for carefully selected patients treated by experienced multidisciplinary teams.
Important limitations
This was a retrospective study from one specialized center, not a randomized clinical trial. The treatment groups differed in cancer type, previous chemotherapy, and other characteristics. Some patients underwent more than one PIPAC procedure, and the analysis treated each procedure separately.
Patients with bowel obstruction or a history of bowel obstruction were excluded, so the findings may not apply to people at greater risk for gastrointestinal complications. The study also did not determine how uninterrupted bevacizumab affects long-term complications, treatment response, cancer progression, or survival.
What this means for patients
This study provides an encouraging early safety signal, but it is not sufficient to establish uninterrupted bevacizumab as the standard approach for everyone receiving PIPAC. Larger, prospective studies involving multiple cancer centers are needed.
Patients should not change the timing of bevacizumab or other treatments without consulting their care team. Questions to discuss may include:
Why is PIPAC being considered in my situation?
What risks could bevacizumab create around the procedure?
Should my treatment be paused, and for how long?
How will my team monitor for bleeding, bowel complications, and wound-healing problems?
Does the treating center have experience coordinating PIPAC with systemic therapy?
PIPAC remains a specialized treatment that is still being evaluated. Decisions about PIPAC and bevacizumab should be individualized based on the patient’s diagnosis, treatment history, overall health, and potential risks.
