First of all I would like to commend the authors for providing us a pictorial evidence of bevacizumab induced loss of integrity of viscus.

This article reminds me of two quotes by Sir Robert Hutchison. The first one being, “It is always well, before handing the cup of knowledge to the young, to wait until the froth has settled”. The second one happens to be, “from too much zeal for the new and contempt for what is old, Good Lord deliver us”.

‘Targeted therapy’ may be the future of oncology. But at this day and age, it is more of a hype than real substance. These theoretically strong agents, which fail in vivo due to various factors, known and unknown, have been notorious for being ‘approved’ and then being either unused, because of cost, or pulled off because of lack of a cost-benefit ratio, or as in the recent case of the NICE rejection of bevacizumab in colorectal carcinoma, toxicity or ineffectiveness.

Inhibiting pathways with targeted therapy, without knowing the entire spectrum of activity of the agent within the body may turn out to be a sour experience.

This article depicts the side-effect of bevacizumab, a VEGF inhibitor, causing esophageal perforation which might have led to deterioration in quality of life of the patient involved. This small but educative pictorial depiction stresses upon the fact that targeted therapy has been at instances and situations, turning out to be a double edged sword, rather than the magic bullet it was hyped to be.

Swaroop Revannasiddaiah
Reviewer

Tracheal Fistula Associated with Bevacizumab 20 Months after Mediastinal Radiation