The impact of Bevacizumab on mucosal healing after dental extraction in patients undergoing cancer treatment in the central region of Algeria

Abstract

Abstract Objectives: Bevacizumab currently stands as the most prescribed anti-VEGF medication in oncology. It functions as an angiogenesis inhibitor, thereby slowing down tumor progression. However, this drug is associated with side effects both in general health and in the oral cavity. To assess the impact of Bevacizumab on mucosal healing after dental extraction in patients undergoing cancer treatment in the central region of Algeria. Materials and Methods: We conducted a cohort study that was comparative, prospective, and multicentric, carried out from June 2018 to September 2021. The sample was divided into two groups: the "With Bevacizumab" group consisted of patients on Bevacizumab with or without chemotherapy, and the second group "Without Bevacizumab" consisted of patients exclusively under conventional chemotherapy. These patients underwent dental extractions without interrupting their antineoplastic treatment. Additionally, the dental extraction protocol adhered to certain conditions, including antibiotic prophylaxis, vasoconstrictor-free anesthetic, and tight sutures. Mucosal healing was evaluated and monitored at 7, 15, and 30 days. Data analysis was performed using Python v. 3.8.16 software. Results: In total, 1250 cancer-treated patients were examined. Among them, 120 patients met the inclusion criteria, with a mean age of 52.08 ± 10.31 years, and they received an average dose of 547.9 ± 239.32 mg of Bevacizumab per cycle over an average duration of 40.08 ± 31.66 weeks. The mean total duration of treatment-free interval with Bevacizumab was estimated at 23.13 ± 7.03 days, with 12.85 ± 5.58 days before and 10.28 ± 4.68 days after dental extraction. Mucosal healing delay was only observed in the "With Bevacizumab" group (15.3% vs. 0.0%, p=0.040). Conclusions: Dental extraction is feasible during Bevacizumab treatment considering the disadvantages associated with interrupting anti-angiogenic treatment, despite the observed delay in epithelialization in our study. Clinical Relevance: Our results were able to demonstrate delayed mucosal healing (lack of epithelialization) beyond one month after tooth extraction.