Gastrointestinal Perforation With an Intraluminal Stent and Bevacizumab Use in Advanced Metastatic Colorectal Cancer

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2021 Feb 25

PMID 33628692

Citations 2

Authors

Nouf Akeel

Wafaa A Toonsi

Affiliations

Soon will be listed here.

Abstract

Intestinal obstruction is a common acute presentation of advanced rectal cancer, which could be managed with surgical or non-surgical techniques including metallic stenting. Bevacizumab has been gaining popularity in the treatment of advanced colorectal cancer (CRC) in combination with different chemotherapeutic agents, to improve the overall survival rate; however, data regarding the adverse effects of bevacizumab in combination with other treatment modalities have been insufficient. Herein, we present a case of a 37-year-old man diagnosed with advanced rectal cancer with concurrent liver and lung metastases. He was started on Xelox (capecitabine plus oxaliplatin) chemotherapy in combination with bevacizumab for palliative care. He developed an episode of bowel obstruction, which was managed with emergent placement of a metallic stent. Soon after that, the patient presented emergently with signs and symptoms of intestinal perforation. He underwent emergent surgical intervention with stoma creation and a complicated hospital course. Despite the oncological benefits of bevacizumab for treating metastatic CRC, complications can occur resulting in a devastating outcome, with intestinal perforation being the most serious rare complication.

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References

Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M . Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004; 99(10):2051-7. DOI: 10.1111/j.1572-0241.2004.40017.x. View

Torre L, Siegel R, Ward E, Jemal A . Global Cancer Incidence and Mortality Rates and Trends--An Update. Cancer Epidemiol Biomarkers Prev. 2015; 25(1):16-27. DOI: 10.1158/1055-9965.EPI-15-0578. View

Sliesoraitis S, Tawfik B . Bevacizumab-induced bowel perforation. J Am Osteopath Assoc. 2011; 111(7):437-41. View

Mainar A, de Gregorio Ariza M, Tejero E, Tobio R, Alfonso E, Pinto I . Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery--results of a multicenter study. Radiology. 1999; 210(1):65-9. DOI: 10.1148/radiology.210.1.r99ja0665. View

van Hooft J, van Halsema E, Vanbiervliet G, Beets-Tan R, DeWitt J, Donnellan F . Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2014; 46(11):990-1053. DOI: 10.1055/s-0034-1390700. View

Alvarez J, Baldonedo R, Bear I, Truan N, Pire G, Alvarez P . Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg. 2005; 190(3):376-82. DOI: 10.1016/j.amjsurg.2005.01.045. View

Yamaguchi T, Gotoh Y, Hattori H, Katsuno H, Imaizumi K . Gastrointestinal perforation during treatment with erlotinib plus bevacizumab in two patients with non-small cell lung cancer exhibiting epidermal growth factor receptor mutations: A case report. Oncol Lett. 2018; 16(1):1046-1050. PMC: 6019947. DOI: 10.3892/ol.2018.8708. View

Giantonio B, Catalano P, Meropol N, ODwyer P, Mitchell E, Alberts S . Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol. 2007; 25(12):1539-44. DOI: 10.1200/JCO.2006.09.6305. View

Imbulgoda A, MacLean A, Heine J, Drolet S, Vickers M . Colonic perforation with intraluminal stents and bevacizumab in advanced colorectal cancer: retrospective case series and literature review. Can J Surg. 2015; 58(3):167-71. PMC: 4447509. DOI: 10.1503/cjs.013014. View

10.

Baron T, Kozarek R . Endoscopic stenting of colonic tumours. Best Pract Res Clin Gastroenterol. 2004; 18(1):209-29. DOI: 10.1016/S1521-6918(03)00098-2. View

11.

Saif M, Elfiky A, Salem R . Gastrointestinal perforation due to bevacizumab in colorectal cancer. Ann Surg Oncol. 2007; 14(6):1860-9. DOI: 10.1245/s10434-006-9337-9. View

12.

Targownik L, Spiegel B, Sack J, Hines O, Dulai G, Gralnek I . Colonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc. 2004; 60(6):865-74. DOI: 10.1016/s0016-5107(04)02225-4. View

13.

Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rodel C, Cervantes A . Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018; 29(Suppl 4):iv263. DOI: 10.1093/annonc/mdy161. View

14.

Ferrara N, Hillan K, Gerber H, Novotny W . Discovery and development of bevacizumab, an anti-VEGF antibody for treating cancer. Nat Rev Drug Discov. 2004; 3(5):391-400. DOI: 10.1038/nrd1381. View

15.

Chen H, Mooney M, Boron M, Vena D, Mosby K, Grochow L . Phase II multicenter trial of bevacizumab plus fluorouracil and leucovorin in patients with advanced refractory colorectal cancer: an NCI Treatment Referral Center Trial TRC-0301. J Clin Oncol. 2006; 24(21):3354-60. DOI: 10.1200/JCO.2005.05.1573. View

16.

Gordon M, Cunningham D . Managing patients treated with bevacizumab combination therapy. Oncology. 2005; 69 Suppl 3:25-33. DOI: 10.1159/000088481. View

17.

Yu X, Wang Q, Xiao W, Chang H, Zeng Z, Lu Z . Neoadjuvant oxaliplatin and capecitabine combined with bevacizumab plus radiotherapy for locally advanced rectal cancer: results of a single-institute phase II study. Cancer Commun (Lond). 2018; 38(1):24. PMC: 5993137. DOI: 10.1186/s40880-018-0294-z. View