Reactions 1704, p67 - 2 Jun 2018 Gastrointestinal perforation: 4 case reports In a case series, one man and three women aged 69-82 years were described, who developed gastrointestinal perforation during treatment with bevacizumab [routes not stated]. Case 1: An 82-year-old man, who had rectal cancer with liver metastases, started receiving bevacizumab 5 mg/kg with FOLFIRI regimen comprising of irinotecan, folinic acid and fluorouracil for a recurrence of liver metastases. On day 22 of 32 cycles of bevacizumab (on day 568 of bevacizumab initiation), he developed fever. A thoracoabdominal CT scan showed pleural effusion and perforation in the oesophagus and in the lower part of the chest. He underwent thoracotomy drainage. On the day 71 post-surgery, he died due to septicaemia. Case 2: A 69-year-old woman, who had rectal cancer with liver/lung metastases, had undergone metal stent placement. She started receiving bevacizumab 5 mg/kg with FOLFOX4 regimen comprising of oxaliplatin, folinic acid and fluorouracil. On sixth day of the third cycle of bevacizumab (on day 41 of bevacizumab initiation), she developed abdominal pain and fever. An abdominal CT scan revealed free air and ascites. Approximately 5mm of perforation was seen in the rectal tumour area and part of the stent was exposed. Therefore, the perforated area was closed with a suture and a colostomy was performed. On day 29 after the surgery, she died due to metastatic rectal cancer. Case 3: A 69-year-old woman, who had left lung cancer with adrenal gland/lymph node metastases, started receiving bevacizumab 15 mg/kg along with carboplatin and pemetrexed. On day 15 of the second cycle of bevacizumab (on day 42 of bevacizumab initiation), she developed pain. An abdominal CT scan revealed free air. Therefore, a surgery was performed. Thereafter, an area of perforation of approximately 3mm was seen in the ileum and an ileocecal resection was carried out. The post-operative course was good with no ruptured sutures. On day 63 after the surgery, she died due to metastatic left lung cancer. Case 4: A 73-year-old woman, who had left lung cancer with pleural metastasis, started receiving bevacizumab 15 mg/kg along with carboplatin and pemetrexed. On day 30 of the first cycle of bevacizumab, she developed pain. An abdominal CT scan showed thickening in the diverticulum and wall of the sigmoid colon along with free air in the area. Therefore, she underwent surgery. The perforation area of the sigmoid colon diverticulum was closed with a suture and a colostomy was carried out. The post-surgical course was good and she remained alive. Author comment: The frequency of digestive tract perforation as a severe side effect of [bevacizumab] is 0.9-1.9%. In this report we have investigated the clinical characteristics of four cases in which digestive tract perforation occurred during chemotherapy in combination with [bevacizumab]. Uemura K, et al. Four Cases of Gastrointestinal Perforation Associated with Bevacizumab. Gan to Kagaku Ryoho 44: 1604-1606, No. 12, Nov 2017 [Japanese; Summarised from a translation] - Japan 803322783 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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