Late anastomotic colonic dehiscence due to antiangiogenic treatment, a specific drug-class complication requiring specific treatment: an example of pazopanib complication

Clin Res Hepatol Gastroenterol. 2011 Feb;35(2):135-9. doi: 10.1016/j.clinre.2010.10.003.

Abstract

Bevacizumab, a recombinant humanized monoclonal antibody against vascular endothelial growth factor (VEGF), was the first angiogenesis inhibitor approved for the first-line treatment of metastatic colorectal cancer in combination with intravenous fluorouracil-based chemotherapy. Two major cohort studies--BRiTE and BEAT--reported a 2% incidence of bowel perforation, which remains a rare, but serious, complication of bevacizumab treatment. Late anastomotic complications, arising > 3 months after surgery, are emerging occurrences that may be associated with bowel perforation. We report here on such a case caused by pazopanib, a new antiangiogenic agent, and also include a review of the published cases in the literature (n = 23) and an analysis of their management. Proctectomy was the initial surgery in 17 patients (74%) with rectal cancer, and 13 of these patients had undergone adjuvant radiation prior to surgery. The majority (84%) of the complications occurred with antiangiogenic treatment after a mean number of four cycles. Patients' management was invariably associated with withdrawal of the antiangiogenic agent, together with conservative treatment in 14 patients (66%).

Publication types

  • Case Reports

MeSH terms

  • Anastomosis, Surgical / adverse effects
  • Angiogenesis Inhibitors / administration & dosage
  • Angiogenesis Inhibitors / adverse effects*
  • Anti-Bacterial Agents / therapeutic use
  • Carcinoma / drug therapy*
  • Carcinoma / secondary
  • Carcinoma / surgery
  • Colectomy* / adverse effects
  • Female
  • Humans
  • Hysterectomy
  • Indazoles
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Ovarian Neoplasms / drug therapy*
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery
  • Ovariectomy
  • Peritoneal Neoplasms / drug therapy*
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / surgery
  • Pyrimidines / administration & dosage
  • Pyrimidines / adverse effects*
  • Salpingectomy
  • Sulfonamides / administration & dosage
  • Sulfonamides / adverse effects*
  • Surgical Wound Dehiscence / chemically induced*
  • Surgical Wound Dehiscence / drug therapy
  • Treatment Outcome

Substances

  • Angiogenesis Inhibitors
  • Anti-Bacterial Agents
  • Indazoles
  • Pyrimidines
  • Sulfonamides
  • pazopanib