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Vascular endothelial growth factor inhibiting drug specific toxicities
Gastrointestinal perforation

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Gastrointestinal perforation

Acute Oncology Guidelines

GI perforation occurs <2%, but can be life-threatening. Perforation occurs within the first 60 days in most.

Managing risk of GI perforation with VEGF-i therapy

Patients with acute diverticulitis, SABO/obstruction, abdominal carcinomatosis, unresected colorectal primary tumours or with a history of previous pelvis/abdominal radiation are at an increased risk for GI perforation and must be monitored for early symptoms and signs of perforation.
Prescribe with caution in patients with diverticulosis, peptic ulcers, chronic NSAID use if GI endoscopic procedure within 3 months - evaluate risks vs benefits in each individual.
GI endoscopic procedures should be delayed, if possible, until after VEGF-i treatment.
Treat patients with active peptic ulcer disease with a proton pump inhibitor (PPI) while on VEGF-i treatment.
Discontinue VEGF-i if GI perforation.
Manage GI perforation according to its severity, with input from surgeons. Risk for impaired wound healing or wound complications during VEGF-i therapy.

Last reviewed: 05/01/2024

Next review date: 05/01/2027

Author(s): Edinburgh Cancer Centre.

Version: 1.1

Approved By: Authorised by CTAC. Refer to Q-Pulse for approval details.

Reviewer name(s): Stewart J.