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Park DJ, Lee D, Park IK. Pneumatosis cystoides intestinalis induced by sunitinib therapy in a patient with metastatic renal cell carcinoma: A case report. Medicine (Baltimore) 2024; 103:e39075. [PMID: 39058831 PMCID: PMC11272240 DOI: 10.1097/md.0000000000039075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts in the gastrointestinal tract and is associated with numerous conditions. Benign PCI can occur secondary to certain medications, such as anticancer-targeted therapies. Here, we report a rare case of PCI that developed following sunitinib therapy for metastatic RCC and was successfully managed with conservative treatment without surgery. PATIENT CONCERNS A 57-year-old woman with a medical history of metastatic renal cell carcinoma (RCC) referred to the Department of General Surgery after completion of the 16th cycle of sunitinib because of abnormal findings on abdominopelvic computed tomography (CT), suggesting necrotizing enteritis with pneumoperitoneum involving the ileum. At the time of presentation to the Department of General Surgery, she was asymptomatic and had no abnormal findings on examination other than the imaging findings. DIAGNOSIS Sunitinib-induced PCI, metastatic RCC, liver cirrhosis, and diabetes mellitus. INTERVENTIONS She was admitted to the general ward for conservative treatment, and sunitinib was discontinued. Conservative treatments included nil per os, total parenteral nutrition, antibiotics, H2-blockers, and oxygen therapy. OUTCOMES On the fifth day of hospitalization, the PCI showed moderate resolution on plain radiography, and she was discharged on the seventh day. Follow-up CT imaging 3 months later demonstrated complete resolution of PCI. CONCLUSION This case emphasizes that the decision between conservative versus surgical treatment for PCI should be based not solely on radiological findings but rather on a comprehensive assessment, including the underlying condition, vital signs, physical examinations, and blood tests.
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Affiliation(s)
- Dong Jin Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Donghyoun Lee
- Department of Surgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - In Kyu Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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2
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Patil NS, Larocque N, van der Pol CB, Torres C, Raptis DA, Patlas MN. Chemotherapy-Induced Toxicities: An Imaging Primer. Can Assoc Radiol J 2022; 74:432-445. [PMID: 35968850 DOI: 10.1177/08465371221120263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The Coronavirus Disease of 2019 (COVID-19) pandemic has caused significant delays in the delivery of cancer treatments in Canada. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging, and can affect multiple organ systems. The purpose of this review is to offer a unified resource for general radiologists regarding the imaging appearances of chemotherapy-induced toxicities.
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Affiliation(s)
- Nikhil S. Patil
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Natasha Larocque
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Christian B. van der Pol
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Canada
| | - Carlos Torres
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
| | - Demetrios A. Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, USA
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3
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Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review. Cancers (Basel) 2022; 14:cancers14071666. [PMID: 35406436 PMCID: PMC8996919 DOI: 10.3390/cancers14071666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Anticancer treatments commonly cause adverse events (AE). Among others, pneumatosis intestinalis (PI) is reported to be infrequent, though it can lead to severe consequences. The aim of our systematic review was to investigate the concurrency of PI and oncological therapy exposure; moreover, we defined the characteristics of patients and the primarily involved tumor types. We analyzed 88 different episodes of PI. The median time of onset was 6 weeks and oncological patients with respiratory system cancers and those treated with targeted therapies appeared be at higher risk. Symptoms were frequently mild to absent; nevertheless, life-threatening complications were reported. Therefore, this AE, although uncommon, should be considered in the case of specific symptoms. Potential pharmacological mechanisms of anticancer drugs in inducing PI are also discussed. Abstract Pneumatosis intestinalis (PI) is a rare condition due to the presence of gas within the bowel wall; it is mainly caused by endoscopic procedures, infections and other gastrointestinal diseases. Oncological therapies have been reported to be a cause of PI as well, but their role is not clearly defined. This systematic review investigates the concurrency of PI and antitumor therapy in cancer patients, considering both solid tumors and onco-hematological ones. We performed a literature review of PubMed, Embase and the Web of Science up to September 2021 according to the PRISMA guidelines. A total of 62 papers reporting 88 different episodes were included. PI was mainly reported with targeted therapies (sunitinib and bevacizumab above all) within the first 12 weeks of treatment. This adverse event mostly occurred in the metastatic setting, but in 10 cases, it also occurred also in the neoadjuvant and adjuvant setting. PI was mostly localized in the large intestine, being fatal in 11 cases, while in the remaining cases, symptoms were usually mild, or even absent. A significant risk of PI reoccurrence after drug reintroduction was also reported (6/18 patients), with no fatal outcomes. Potential pharmacological mechanisms underlying PI pathogenesis are also discussed. In conclusion, although uncommonly, PI can occur during oncological therapies and may lead to life-threatening complications; therefore, consideration of its occurrence among other adverse events is warranted in the presence of clinical suspicion.
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Toda S, Iwasaki H, Murayama D, Isoda M, Nakayama H, Suganuma N, Masudo K. Pneumatosis intestinalis associated with lenvatinib during thyroid cancer treatment: a case report. J Med Case Rep 2021; 15:556. [PMID: 34763724 PMCID: PMC8588671 DOI: 10.1186/s13256-021-03158-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pneumatosis intestinalis is a rare disease characterized by gas-filled cysts within the submucosa or serosa of the intestinal tract. In recent years, pneumatosis intestinalis was reported in patients undergoing cancer treatment, and some case reports exist that report that pneumatosis intestinalis occurs during administration of vascular endothelial growth factor inhibitors, such as bevacizumab and sunitinib. Here, we report the first case of pneumatosis intestinalis during lenvatinib treatment. CASE PRESENTATION A 77-year-old Japanese man presented to our hospital with a chief complaint of numbness in the right leg and weakness of the lower limbs 9 years after right thyroid lobectomy. Computed tomography showed a tumor 90 mm in size from the lumbar spine to the sacrum, causing spinal cord compression. Blood tests showed that the patient's thyroglobulin level was increased to 11,600 ng/ml. We diagnosed him with thyroid cancer with bone metastases. External beam radiotherapy (39 Gy/13 Fr) was performed on the bone metastases, followed by total thyroidectomy and radioactive iodine therapy. Four months after radioactive iodine therapy, lenvatinib was introduced because the symptoms of numbness and weakness recurred. Lenvatinib was introduced at dose of 24 mg, and then it was reduced to 14 mg owing to Common Terminology Criteria for Adverse Event grade 3 paronychia of the right foot. Although no further significant adverse events occurred, a scheduled computed tomography image showed pneumatosis intestinalis of the ascending colon 14 weeks after the introduction of lenvatinib. No abdominal or digestive symptoms were observed; therefore, we selected conservative treatment. We discontinued lenvatinib for a week, but we were required to restart lenvatinib as the numbness in the right leg worsened after withdrawal. Since the introduction of lenvatinib, 3 years and 5 months passed; we continued lenvatinib treatment, and the therapeutic effect remains partial response. There has been no recurrence of pneumatosis intestinalis. CONCLUSIONS Although rare, it is important to recognize that pneumatosis intestinalis can occur in association with lenvatinib and should be differentiated from intestinal perforation. Pneumatosis intestinalis association with lenvatinib can be improved by withdrawal.
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Affiliation(s)
- Soji Toda
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
| | - Hiroyuki Iwasaki
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Daisuke Murayama
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Maya Isoda
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Nobuyasu Suganuma
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.,Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Katsuhiko Masudo
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan
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Nunomiya K, Inoue S, Sato K, Igarashi A, Yamauchi K, Abe Y, Watanabe M. Pneumatosis Intestinalis in Lung Cancer Induced Twice by Different Drugs: Bevacizumab and Pemetrexed. Intern Med 2021; 60:2109-2113. [PMID: 33551401 PMCID: PMC8313921 DOI: 10.2169/internalmedicine.5564-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 72-year-old man diagnosed with stage 4 lung adenocarcinoma developed asymptomatic pneumatosis intestinalis while undergoing treatment with first-line chemotherapy, which included carboplatin, paclitaxel, and bevacizumab (BEV). He was treated conservatively. The pneumatosis recurred while the patient was undergoing treatment with the third-line chemotherapy, which included pemetrexed (PEM). His condition resolved after 4 weeks of supportive therapy. To our knowledge, this is the first case in which pneumatosis intestinalis was induced twice by two drugs in a patient with lung cancer. BEV and PEM are often administered to patients with lung cancer; thus, it should be noted that pneumatosis intestinalis may occur as an adverse event in patients treated with these drugs.
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Affiliation(s)
- Keiko Nunomiya
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Japan
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Japan
| | - Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Japan
| | - Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Japan
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Japan
| | - Yuki Abe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Japan
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6
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A case of immune checkpoint inhibitor-related colitis with a distinctive endoscopic finding of colonic pseudolipomatosis. Clin J Gastroenterol 2021; 14:1431-1436. [PMID: 34106395 DOI: 10.1007/s12328-021-01459-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
A man in his 70s received anticancer chemotherapy with the anti-programmed cell death protein-ligand 1 antibody atezolizumab for non-small cell lung cancer. Ten days later, he developed diarrhea and skin rash, which were suspected to be due to immune-related adverse events, and was treated with prednisolone for 2 weeks. Five weeks after atezolizumab administration, he was admitted to our hospital for Common Terminology Criteria for Adverse Events Grade 3 diarrhea and hematochezia. Sigmoidoscopy revealed a dark red color in the mucosa of the transverse colon and multiple whitish mucosal plaques extending from the transverse colon to the rectum. Biopsy specimens revealed empty vacuoles in the lamina propria with infiltration of numerous inflammatory cells, including CD8+ T cells. Based on the findings of sigmoidoscopy and histology, the diagnosis was immune checkpoint inhibitor-related colitis with colonic pseudolipomatosis. The endoscopic findings and symptoms were markedly improved by prednisolone administration. We herein report the first case of immune checkpoint inhibitor-related colitis with characteristic endoscopic findings of colonic pseudolipomatosis. It is important to perform endoscopy and histological evaluation to determine the differential diagnosis and treatment strategy for patients treated with immune checkpoint inhibitors.
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Chaudhry NS, Bi WL, Gupta S, Keraliya A, Shimizu N, Chiocca EA. Pneumatosis Intestinalis After Molecular-Targeted Therapy. World Neurosurg 2019; 125:312-315. [PMID: 30763745 DOI: 10.1016/j.wneu.2019.01.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pneumoperitoneum after surgical manipulation of the abdomen implies a perforation. Rare cases of nonoperated cancer patients, largely with gastrointestinal or genitourinary cancers, have been noted to have radiologic findings of pneumatosis intestinalis and/or pneumoperitoneum as a complication of molecular-targeted therapy (MTT) without confounding factors for perforation. We present a patient with a cranial malignancy treated with bevacizumab who subsequently manifested with pneumatosis intestinalis. CASE DESCRIPTION A 67-year-old man with metastatic melanoma, non-small cell lung cancer, and recurrent cerebellar subependymoma was initiated on bevacizumab treatment for subependymoma recurrence. He subsequently underwent an uncomplicated ventriculoperitoneal shunt for progressive obstructive hydrocephalus, confirmed by a normal postoperative abdominal radiograph. One week later, he returned with worsening lethargy and a computed tomography consistent with pneumomediastinum and pneumoperitoneum. Due to concern for bowel perforation, the patient underwent diagnostic laparoscopy and removal of ventriculoperitoneal shunt. Focal sigmoid pneumatosis was identified without any signs of bowel perforation or ischemia. Bevacizumab was discontinued, and the patient's radiologic and clinical findings improved. CONCLUSIONS With increasing utilization of MTTs in brain tumor management, we raise MTT as a potential cause for pneumoperitoneum in neurosurgical patients. Pneumoperitoneum after extracranial procedures still requires workup and management for potential bowel perforation, but alternative causes such as bevacizumab should also be considered. Pneumatosis intestinalis patients on MTT can have benign physical examinations and will resolve, in the majority of cases, on discontinuation of the drug.
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Affiliation(s)
- Nauman S Chaudhry
- Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abhishek Keraliya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naomi Shimizu
- Department of Trauma, Burns, and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Rectovaginal fistula during treatment with axitinib in a patient with renal cell carcinoma: a case report and review of the literature. Anticancer Drugs 2019; 30:425-427. [PMID: 30640790 DOI: 10.1097/cad.0000000000000742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal cell carcinoma (RCC) is one of the most frequent malignancies of the adults. Its incidence has been increasing steadily by 2-4% each year. Up to 30% of patients present with metastases at diagnosis. It is a highly vascularized cancer because of the hypoxia-induced factor stabilization as a consequence of von Hippel-Lindau inactivation. Hypoxia-induced factor accumulation leads to transactivation of molecules involved in angiogenesis including vascular endothelial growth factor (VEGF) and platelet-derived growth factor. Sunitinib is an oral tyrosine kinase inhibitor that interacts with several angiogenesis receptors including platelet-derived growth factor receptors and VEGF receptors, and is approved for the first-line treatment in metastatic RCC. In terms of tolerability, patients treated with sunitinib showed a higher incidence of diarrhea, vomiting, hypertension, hand-foot syndrome, and neutropenia, a safety profile consistent with what had been observed in earlier phase studies. Axitnib is a potent and selective tyrosine kinase inhibitor of VEGF receptors 1, 2, and 3, and is approved in the second-line setting for patients with metastatic RCC. The tolerability profile of axitinib is favorable. The most commonly reported treatment-related adverse events are diarrhea, hypertension, fatigue, nausea, and dysphonia. Bowel toxicity, especially pneumatosis intestinalis and bowel perforation, is very uncommon. In particular, the incidence of intestinal perforation or fistulae is not well known for sunitinib or axitinib. Here, for the first time, we report the incidence of rectovaginal fistula in a 57-year-old White woman, with RCC, following treatment with sunitinib and axitinib.
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Asahi Y, Suzuki T, Sawada A, Kina M, Takada J, Gotoda H, Masuko H. Pneumatosis Cystoides Intestinalis Secondary to Sunitinib Treatment for Gastrointestinal Stromal Tumor. Case Rep Gastroenterol 2018; 12:432-438. [PMID: 30186096 PMCID: PMC6120377 DOI: 10.1159/000490657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/05/2018] [Indexed: 12/14/2022] Open
Abstract
A 67-year-old man with liver and retroperitoneal metastases from a gastrointestinal stromal tumor arising in the jejunum had been administered oral sunitinib for 2 months. He presented to our department with right-sided lower abdominal pain. His general condition was good, with no high-grade fever, and the other vital signs were also stable. Contrast-enhanced computed tomography was promptly performed, and pneumatosis cystoides intestinalis (PCI) was detected in a wide area around the ileocecal lesion. There were no signs of acute abdomen requiring emergency surgery due to conditions such as intestinal perforation, ischemia, or obstruction. Sunitinib was discontinued and the patient was placed on nil orally with intravenous infusion. PCI resolved promptly and the patient was discharged on the 21st day after admission. PCI is a rare side effect of sunitinib with only 8 cases reported previously, which can complicate with acute abdomen or gastrointestinal perforation, in some cases. Thus, the early identification of sunitinib as the cause of PCI is important. Although PCI is a rare adverse effect of sunitinib, clinicians must be aware of it to promptly provide the correct diagnosis and treatment.
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Affiliation(s)
- Yoh Asahi
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Takuto Suzuki
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Akiufumi Sawada
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Masaya Kina
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Joji Takada
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Hiroko Gotoda
- Department of Clinical Pathology, Nikko Memorial Hospital, Muroran, Japan
| | - Hiroyuki Masuko
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
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Uruga H, Moriguchi S, Takahashi Y, Ogawa K, Murase K, Mochizuki S, Hanada S, Takaya H, Miyamoto A, Morokawa N, Kishi K. Gefitinib successfully administered in a lung cancer patient with leptomeningeal carcinomatosis after erlotinib-induced pneumatosis intestinalis. BMC Cancer 2018; 18:825. [PMID: 30115025 PMCID: PMC6097412 DOI: 10.1186/s12885-018-4743-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
Background Pneumatosis intestinalis (PI) is a rare complication of chemotherapy, characterized by multiple gas accumulations within the bowel wall. Case presentation A 71-year-old woman with epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma was admitted to our hospital because of reduced consciousness. She was diagnosed as having leptomeningeal carcinomatosis (LM) using lumbar puncture. Because she could not swallow a tablet, erlotinib was administered via a feeding tube. Her state of consciousness gradually improved, but she experienced diarrhea several times a day. After 3 weeks of erlotinib therapy, PI occurred. Erlotinib was discontinued and PI was resolved after treatment with conservative therapies. Erlotinib was re-administrated and PI occurred again. After improvement of erlotinib-induced PI, gefitinib was administered by a feeding tube and the patient did not experience PI or diarrhea. The patient survived 8 months from the diagnosis of LM. Conclusion PI is one of the side effects of erlotinib, and consecutive therapies are useful for the treatment of PI. In this patient, gefitinib was successfully administered after erlotinib-induced PI.
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Affiliation(s)
- Hironori Uruga
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. .,Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
| | - Shuhei Moriguchi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yui Takahashi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kazumasa Ogawa
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kyoko Murase
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Sayaka Mochizuki
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Shigeo Hanada
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Hisashi Takaya
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Atsushi Miyamoto
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Nasa Morokawa
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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11
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Lee YS, Han JJ, Kim SY, Maeng CH. Pneumatosis cystoides intestinalis associated with sunitinib and a literature review. BMC Cancer 2017; 17:732. [PMID: 29121860 PMCID: PMC5679335 DOI: 10.1186/s12885-017-3744-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/31/2017] [Indexed: 12/11/2022] Open
Abstract
Background Pneumatosis cystoides intestinalis (PCI) is a rare self-limiting condition characterized by air-filled cysts within intestinal walls. Diagnosis should be prudent because it can mimic pneumoperitoneum leading to unnecessary treatment such as surgical exploration. Although various drugs including anti-neoplastic agents have been suggested as etiologies, cases related to sunitinib are sparse. Because of the rarity of this unusual side effect by sunitinib, we report the case report. Case presentation A 68-year-old female with pancreatic neuroendocrine tumor who was treated with sunitinb for 4 months visited to our hospital complaining of severe diarrhea and mild abdominal discomfort. The abdominal X-ray showed subdiaphragmatic air mimicking intestinal perforation. After the meticulous evaluation including abdomino-pelvic computed tomography, the patient was diagnosed of PCI induced by sunitinib and fully recovered with conservative management. Conclusions It is important to note that PCI can develop after treatment with sunitinib because PCI has not been widely known as an adverse event caused by the agent. Furthemore, emergent surgery while sunitinib was administrated without adequate washout period can result in substantial surgical complications which could be avoided with the precise diagnosis.
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Affiliation(s)
- Yong Suk Lee
- Division of Medical Oncology-Hematology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, (02447) 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - Jae Joon Han
- Division of Medical Oncology-Hematology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, (02447) 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - Si-Young Kim
- Division of Medical Oncology-Hematology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, (02447) 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea
| | - Chi Hoon Maeng
- Division of Medical Oncology-Hematology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, (02447) 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea.
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Kameda T, Nakano K, Yamazaki M, Koshimizu T, Morita T. Axitinib-induced Pneumatosis Intestinalis and Acute Acalculous Cholecystitis in a Patient With Renal Cell Carcinoma. Urology 2017; 101:e7-e8. [PMID: 28039049 DOI: 10.1016/j.urology.2016.12.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 09/24/2016] [Accepted: 12/20/2016] [Indexed: 11/18/2022]
Abstract
A 71-year-old man with metastatic renal cell carcinoma presented with abdominal pain during treatment with axitinib. The diagnoses were axitinib-induced pneumatosis intestinalis (PI) and acute acalculous cholecystitis (AC). The patient's condition improved with antibiotics, bowel rest, and discontinuation of the axitinib therapy. This is the first case report in the literature. PI and AC induced by other vascular endothelial growth factor receptor tyrosine kinase inhibitors are usually self-limiting upon discontinuation of those uses, but can be life-threatening in some cases. We need to be aware of axitinib-induced PI and AC to avoid delayed or inappropriate treatments for them.
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Affiliation(s)
- Tomohiro Kameda
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Kazuhiko Nakano
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | | | | | - Tatsuo Morita
- Department of Urology, Jichi Medical University, Tochigi, Japan.
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Fujimi A, Sakamoto H, Kanisawa Y, Minami S, Nagamachi Y, Yamauchi N, Ibata S, Kato J. Pneumatosis intestinalis during chemotherapy with nilotinib in a patient with chronic myeloid leukemia who tested positive for anti-topoisomerase I antibodies. Clin J Gastroenterol 2016; 9:358-364. [DOI: 10.1007/s12328-016-0683-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/01/2016] [Indexed: 10/21/2022]
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Abstract
Neurologic complications can result from direct or indirect effects of cancer
therapy. Treatment toxicity may affect both the central nervous system and the
peripheral nervous system. Early recognition of these toxicities plays an important
role in the management of patients with cancer.
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Affiliation(s)
- Eva Lu Lee
- MD Anderson Cancer Center, Houston, Texas
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15
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Scoazec JY. [A granulomatous colitis?]. Ann Pathol 2014; 34:238-41. [PMID: 24950875 DOI: 10.1016/j.annpat.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jean-Yves Scoazec
- Service central d'anatomie et de cytologie pathologiques, hôpital Edouard-Herriot, hospices civils de Lyon, 3, place d'Arsonval, 69437 Lyon cedex 03, France.
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Abstract
Tumor-bowel fistula is an under reported complication of abdomino-pelvic malignancies which may occur spontaneously due to tumor growth or can be associated with cancer treatment. Chemotherapy and radiotherapy are commonly responsible for tumor-bowel fistulas. Molecular targeted therapies are a new class of drugs that can cause tumor fistulization due to their antiangiogenic properties. Clinically, the fistula can be asymptomatic or can result in devastating complications. Imaging helps in the prompt detection of these fistulas and the complications associated with them. Management of tumor-bowel fistula is individualized but often involves discontinuation of the associated treatment. Radiologists should promptly alert the oncology team about the presence of tumor-bowel fistula and any risk factors for its occurrence like pneumatosis or large metastatic deposits close to bowel loops.
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O’Rafferty C, McElligott F, Storey L, O’Marcaigh A, Smith O. Pneumatosis intestinalis and imatinib mesylate. Ann Hematol 2014; 93:1783-4. [DOI: 10.1007/s00277-014-2051-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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Tirumani SH, Shinagare AB, Jagannathan JP, Krajewski KM, Ramaiya NH. Multidetector-row CT of tumour-bowel fistula: Experience at a tertiary cancer centre. Clin Radiol 2013; 69:e100-7. [PMID: 24290835 DOI: 10.1016/j.crad.2013.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/21/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
AIM To study the clinical and multidetector computed tomography (MDCT) features of tumour-bowel fistula (TBF). MATERIALS AND METHODS Fifty-one patients (27 women; mean age 57.4 years, range 30-77years) with TBF presenting to our institution between January 2005 and February 2012 were identified retrospectively from the radiology database. MDCT images before, at, and subsequent to diagnosis of TBF were reviewed by three radiologists in consensus; clinical presentation, management, and outcome were documented from electronic medical records. RESULTS Of 51 patients, small bowel (n = 22) was the most common site with gastrointestinal stromal tumour (GIST) being the most common sarcoma subtype (n = 10). TBF was treatment-associated (TTBF) in 40 patients [78%; 22 of whom had received molecular targeted therapy (MTT)], and spontaneous (STBF) in 11 patients (22%). Thirty-one patients (61%) were symptomatic at the time of TBF detection. TTBF was more often asymptomatic (19/40 versus 1/11; Fisher's exact test p = 0.03). In the TTBF group, 16 had a partial response, seven had stable disease, and 17 had progressive disease. Treatment was discontinued or changed to an alternative regimen in 27/40 patients, and 13/40 patients continued with the same regimen. TBF persisted in 27/33 patients (82%) who underwent CT follow-up. Thirty-one of the 51 patients were deceased at the time of analysis. Time from diagnosis of TBF to death was shorter with STBF (1.8 months) than with TTBF (6.4 months). CONCLUSION TBF is often associated with MTT and can be seen with treatment response or progression. TTBF is more frequently asymptomatic. TBF is usually managed conservatively by discontinuing treatment, but often persists on CT follow-up.
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Affiliation(s)
- S H Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - A B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J P Jagannathan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - N H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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20
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Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features. AJR Am J Roentgenol 2013; 200:1042-7. [PMID: 23617487 DOI: 10.2214/ajr.12.8942] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the overall proportion of clinically worrisome and benign pneumatosis intestinalis (PI) occurring in patients with cancer and to evaluate associated risk factors and CT features. MATERIALS AND METHODS We retrospectively studied the CT examinations of 84 patients treated at our tertiary cancer center. Reviewers who were blinded to clinical data and classification analyzed PI in terms of location, pattern (linear, cystic, or both), and associated CT features, including pneumoperitoneum, portomesenteric venous air, bowel wall thickening, bowel dilatation, and ascites. On the basis of the review of clinical information and criteria derived from prior literature, the cases were classified as clinically worrisome PI (underlying bowel disease) or benign PI (diagnosis of exclusion that resolved on follow-up imaging without targeted therapy). Clinical factors reviewed included age, sex, cancer type, steroid use, and chemotherapy administration. RESULTS Forty-seven patients were classified as having benign PI (56%) and the remainder as having clinically worrisome PI (44%). The following imaging features correlated significantly with clinically worrisome PI: bowel wall thickening (p < 0.001), mesenteric stranding (p < 0.001), ascites (p < 0.001), bowel dilatation (p = 0.004), location confined to small bowel (p = 0.012), and portomesenteric venous gas (p = 0.02). Benign PI was significantly associated with PI confined to the colon (p = 0.004). CONCLUSION Benign PI was slightly more prevalent than clinically worrisome PI in our cohort of patients with cancer. The presence of certain CT features (mesenteric stranding, bowel wall thickening, and ascites) and the location of PI may be indicators of more significant bowel disease and, therefore, of clinically worrisome cases. There was no statistical significance achieved for nonimaging clinical factors.
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Pneumatosis intestinalis and bowel perforation associated with molecular targeted therapy: an emerging problem and the role of radiologists in its management. AJR Am J Roentgenol 2013; 199:1259-65. [PMID: 23169717 DOI: 10.2214/ajr.12.8782] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article is to study the imaging features, management, and outcome of pneumatosis intestinalis and bowel perforation associated with molecular targeted therapy. MATERIALS AND METHODS In this retrospective study, 48 patients with cancer who developed pneumatosis or intestinal perforation were found by searching a radiology database. Of these patients, 24 patients (13 women and 11 men; mean age, 61 years; range, 39-83 years) receiving molecular targeted therapy without any confounding factors for pneumatosis or perforation were selected. Initial and follow-up CT scans were evaluated by two radiologists; medical records were reviewed to note clinical features, management, and outcome. RESULTS Seventeen (70.8%) patients were asymptomatic. Colorectal cancer (n = 10) and renal cell carcinoma (n = 5) were the most common malignancies; bevacizumab (n = 14) and sunitinib (n = 6) were the most common associated drugs. Imaging findings included intestinal perforation (20 sites in 18 patients), pneumatosis (n = 10), ascites (n = 8), pneumoperitoneum (n = 7), fistula formation (n = 7), and fluid collections (six collections in five patients). Fifteen (62.5%) patients were treated conservatively, seven (29.2%) underwent surgery, and two (8.3%) underwent percutaneous drainage. Molecular targeted therapy was discontinued in 22 of 24 patients; findings resolved in 19 patients, remained stable in one, and worsened in one. One patient died after surgery. In both instances where the drug was continued, the abnormality worsened. Findings recurred in three of four patients in whom the drug was restarted after initial resolution. CONCLUSION Radiologists should be aware of intestinal complications associated with molecular targeted therapy, including pneumatosis, bowel perforation, and fistula formation. Most patients can be treated conservatively after discontinuation of molecular targeted therapy. Continuing or restarting molecular targeted therapy can cause worsening or recurrent pneumatosis or perforation.
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Genitourinary imaging: part 2, role of imaging in medical management of advanced renal cell carcinoma. AJR Am J Roentgenol 2013; 199:W554-64. [PMID: 23096199 DOI: 10.2214/ajr.12.9233] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Renal cell carcinoma (RCC) comprises 80-85% of all primary renal neoplasms. Knowledge of the genetic and molecular features of RCC and the advent of molecular targeted therapy have revolutionized the treatment of RCC in the past decade. This article will review the changing role of the radiologist in the management of advanced RCC, especially in terms of the new relevance of RCC subtypes, treatment-related changes on imaging, new tumor response criteria, and commonly encountered molecular targeted therapy-related toxicities. CONCLUSION In this era of personalized cancer treatment, imaging has assumed a central role in treatment selection and follow-up of advanced RCC.
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Chikarmane SA, Khurana B, Krajewski KM, Shinagare AB, Howard S, Sodickson A, Jagannathan J, Ramaiya N. What the emergency radiologist needs to know about treatment-related complications from conventional chemotherapy and newer molecular targeted agents. Emerg Radiol 2012; 19:535-46. [PMID: 22673844 DOI: 10.1007/s10140-012-1052-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/10/2012] [Indexed: 12/21/2022]
Abstract
Emergency departments (ED) are increasingly utilized by oncology patients for disease- and treatment-related issues. With the increased use of new molecular targeted therapy (MTT) and conventional chemotherapeutic regimens, oncology patients present with a range of adverse treatment effects, some of which reveal characteristic injury patterns and imaging appearances. Knowledge of these imaging findings is critically important for early detection and prompt management in oncology patients. In this article, we present a brief review of conventional chemotherapeutic and new MTT regimens as well as address adverse reactions that bring oncology patients to the ED.
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Affiliation(s)
- Sona A Chikarmane
- Department of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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24
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Thornton E, Howard SA, Jagannathan J, Krajewski KM, Shinagare AB, O'Regan K, Cleary JM, Ramaiya NH. Imaging features of bowel toxicities in the setting of molecular targeted therapies in cancer patients. Br J Radiol 2012; 85:1420-6. [PMID: 22674709 DOI: 10.1259/bjr/19815818] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Molecular targeted therapies are becoming ubiquitous in cancer treatment. These drugs may cause gastrointestinal toxicities including perforation, pneumatosis, enteritis, colitis and fistula formation. Knowledge of these complications and their management enables early radiological identification and appropriate intervention, reducing patient morbidity and mortality.
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Affiliation(s)
- E Thornton
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, USA
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25
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Lee JY, Han HS, Lim SN, Shim YK, Choi YH, Lee OJ, Lee KH, Kim ST. Pneumatosis intestinalis and portal venous gas secondary to Gefitinib therapy for lung adenocarcinoma. BMC Cancer 2012; 12:87. [PMID: 22405425 PMCID: PMC3314573 DOI: 10.1186/1471-2407-12-87] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 03/10/2012] [Indexed: 12/13/2022] Open
Abstract
Background Pneumatosis intestinalis (PI), defined as the presence of gas in the bowel wall, and portal venous gas (PVG) are relatively rare radiological findings. Although several chemotherapeutic agents and anti-vascular endothelial growth factor agents are reported to be associated with PI and PVG, an association with anti-epidermal growth factor receptor (EGFR) agents has not been described previously. Case presentation The present report describes a case of PI and PVG secondary to treatment with an EGFR tyrosine kinase inhibitor. A 66-year-old woman who had been diagnosed with metastatic lung adenocarcinoma presented with nausea, vomiting and abdominal distension after commencing gefitinib. A computed tomography (CT) scan of the abdomen revealed PI extending from the ascending colon to the rectum, hepatic PVG, and infarction of the liver. Gefitinib therapy was discontinued immediately and the patient was managed conservatively. A follow-up CT scan 2 weeks later revealed that the PI and hepatic PVG had completely resolved. Conclusion This is the first report of PI and PVG caused by EGFR tyrosine kinase inhibitor. Although these complications are extremely rare, clinicians should be aware of the risk of PI and PVG in patients undergoing targeted molecular therapy.
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Affiliation(s)
- Joo Young Lee
- Department of Internal Medicine College of Medicine, Chungbuk National University, 410 Seongbong-ro, Heungduk-Gu, Cheongju 361-711, South Korea
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Vijayakanthan N, Dhamanaskar K, Stewart L, Connolly J, Leber B, Walker I, Trus M. A review of pneumatosis intestinalis in the setting of systemic cancer treatments, including tyrosine kinase inhibitors. Can Assoc Radiol J 2012; 63:312-7. [PMID: 22402108 DOI: 10.1016/j.carj.2011.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 05/29/2011] [Accepted: 06/14/2011] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Pneumatosis intestinalis is a radiologic diagnosis that manifests in a variety of clinical settings. We report 4 cases of pneumatosis intestinalis in patients undergoing cancer treatments that included cytotoxic agents and/or tyrosine kinase inhibitors. These reports aim to provide insight into the clinical interpretation and pathogenesis of pneumatosis intestinalis in the setting of cancer treatments and demonstrate a potential association with tyrosine kinase inhibitors. METHODS Radiologists responsible for the interpretation of adult imaging at our tertiary care centre were surveyed to identify cases of pneumatosis intestinalis arising in the midst of cancer treatment. The case histories were reviewed by physicians with expertise in cancer treatment. RESULTS Four cases of chemotherapy-related pneumatosis intestinalis were identified. The diagnosis was made in 1 patient during investigations undertaken for non-life-threatening abdominal symptoms and incidentally in 2 patients by abdominal imaging used to measure chemotherapy response. A fourth patient presented in a life-threatening manner, and abdominal imaging was symptom guided. Interestingly, 3 of the 4 patients were receiving treatments that included a tyrosine kinase inhibitor, and this agent was the only identifiable potential etiology in 1 patient. CONCLUSIONS The significance of pneumatosis intestinalis arising during cancer treatments is difficult to interpret because of the complex nature of the diseases and the treatments that often include combinations of cytotoxic agents and/or novel therapies. These reports demonstrate the importance of classifying this radiologic finding according clinical severity rather than etiology and underscore the need for continued observation for unexplained adverse effects when using novel therapies.
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Affiliation(s)
- Niranjan Vijayakanthan
- The Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Two cases of bowel perforation associated with sunitinib treatment for renal cell carcinoma. Int J Clin Oncol 2011; 17:412-6. [PMID: 21927829 DOI: 10.1007/s10147-011-0318-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 08/29/2011] [Indexed: 12/21/2022]
Abstract
Sunitinib, a multitargeted tyrosine kinase inhibitor, is widely used in the treatment of carcinoma. Adverse events associated with this treatment, including fatigue, diarrhea, and hematotoxicity, have been reported in clinical trials. Bowel perforation is a surgical emergency that requires immediate treatment depending on the location and progression of the tumor. We report 2 cases of bowel perforation during sunitinib treatment. The patients presented with diffuse peritonitis, and emergency exploratory laparotomy was performed. We speculate that the underlying mechanisms were decrease in capillary density of the normal mucosa in case 1 and tumor shrinkage because of sunitinib treatment in case 2. To the best of our knowledge, this is the first study to report the pathological findings implicating bowel perforation due to sunitinib treatment. Further investigations are needed to clarify the risk factors for intestinal perforations associated with sunitinib treatment.
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Yoon S, Hong YS, Park SH, Lee JL, Kim TW. Pneumatosis intestinalis after cetuximab-containing chemotherapy for colorectal cancer. Jpn J Clin Oncol 2011; 41:1225-8. [PMID: 21835823 DOI: 10.1093/jjco/hyr114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cetuximab, a chimeric monoclonal antibody to epidermal growth factor receptor, is an effective chemotherapeutic agent for patients with metastatic colorectal cancer. Whereas several specific adverse reactions to cetuximab such as skin rash and nail toxicity have been reported, there have been few reports of pneumatosis intestinalis related to cetuximab-containing chemotherapy. We describe here three patients with colorectal cancer who developed pneumatosis intestinalis during treatment with cetuximab-containing chemotherapy, which developed after 7, 19 and 47 weeks of cetuximab treatment, and discovered on routine follow-up computed tomographic scans for response evaluations. None of these patients complained of abdominal pain, showed signs of peritoneal irritation on physical examination or had elevated serum concentrations of acute inflammatory markers. Following cessation of cetuximab and conservative medical treatment, all three patients showed complete resolution of pneumatosis intestinalis on abdominal pelvic computed tomographic scans.
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Affiliation(s)
- Shinkyo Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea
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Tumor fistulization associated with targeted therapy: computed tomographic findings and clinical consequences. J Comput Assist Tomogr 2011; 35:86-90. [PMID: 21245693 DOI: 10.1097/rct.0b013e3181fce2cb] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the computed tomographic (CT) appearances and clinical consequences of tumor fistulization as a complication of targeted therapy for cancer. METHODS The committee on human research approved this Health Insurance Portability and Accountability Act-compliant study and waived written informed consent. Based on the records of the senior author and our multidisciplinary Tumor Boards, we retrospectively identified 4 patients (1 man and 3 women with a mean age of 55.25 years; range, 47 to 64 years) who developed tumor fistulization while being treated with targeted therapy consisting of sunitinib (n = 2); bevacizumab (n = 1); and XL184, an investigational c-Met inhibitor (n = 1). All available clinical, imaging, and histopathological records were reviewed, with particular emphasis on treatment administered, CT findings, and clinical course. RESULTS All 4 patients developed fistulae from large metastatic deposits in the abdomen (mean size before treatment, 10.55 cm; range, 7.4-13.4 cm) to the gastrointestinal tract, and one patient also developed fistulae from a lung metastasis of undetermined size to the bronchial tree. All fistulae manifested as the appearance of air within a pre-existing tumor mass. At the time of fistula detection, disease at other sites in the 4 patients showed signs of regression (n = 1), progression (n = 2), or stability (n = 1). Currently, one patient is alive without evidence of disease, and the 3 other patients are deceased. CONCLUSIONS Targeted therapy can be associated with tumor fistulization to the gastrointestinal tract or tracheobronchial tree; familiarity with the CT findings should facilitate the diagnosis of this complication, which seems to be of variable and patient-specific prognostic significance.
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Torrisi JM, Schwartz LH, Gollub MJ, Ginsberg MS, Bosl GJ, Hricak H. CT Findings of Chemotherapy-induced Toxicity: What Radiologists Need to Know about the Clinical and Radiologic Manifestations of Chemotherapy Toxicity. Radiology 2011; 258:41-56. [DOI: 10.1148/radiol.10092129] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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31
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Coriat R, Ropert S, Mir O, Billemont B, Chaussade S, Massault PP, Blanchet B, Vignaux O, Goldwasser F. Pneumatosis intestinalis associated with treatment of cancer patients with the vascular growth factor receptor tyrosine kinase inhibitors sorafenib and sunitinib. Invest New Drugs 2010; 29:1090-3. [PMID: 20524036 DOI: 10.1007/s10637-010-9458-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/12/2010] [Indexed: 02/08/2023]
Abstract
Recently, pneumatosis intestinalis has been described in patients receiving bevacizumab, a monoclonal antibody to VEGF-A. Pneumatosis intestinalis is a condition characterized by subserosal and submucosal gas-filled cysts in the gastrointestinal tract. We report on pneumatosis intestinalis in patients receiving oral anti-VEGF agents. Patients shared the following characteristics: long-term (> 4 months) exposure to anti-VEGF agents, lack of other factors predisposing to pneumatosis intestinalis, and lack of recent surgical intervention. Taken together, these observations suggest that pneumatosis intestinalis is a probable class-effect of anti-VEGF agents.
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Affiliation(s)
- Romain Coriat
- Center for Research on Angiogenesis Inhibitor, Université Paris Descartes, AP-HP, Teaching Hospital Cochin, Paris, France.
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Stone RL, Sood AK, Coleman RL. Collateral damage: toxic effects of targeted antiangiogenic therapies in ovarian cancer. Lancet Oncol 2010; 11:465-75. [PMID: 20226736 PMCID: PMC3199129 DOI: 10.1016/s1470-2045(09)70362-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
First-line chemotherapy fails in more than 20% of patients with epithelial ovarian cancer and about 40-50% of women who respond to initial treatment relapse within 2 years. In the recurrent setting, second-line chemotherapeutic agents have a 15-20% response rate with no cures. Fortunately, clinical investigations that have assessed the efficacy of new, biologically targeted therapies have reinvigorated therapeutic options for patients living with ovarian and other malignancies. In view of the fact that ovarian cancer is one of the most angiogenic neoplasms, there is great hope that implementing targeted agents with antiangiogenic properties will improve outcomes. However, as experience grows with the antitumour activity of these drugs, new toxic effects are emerging. The effects of antiangiogenic agents on molecules and processes that also have physiologically important roles in healthy tissues are at the crux of these toxic effects, or "collateral damage". This review discusses the leading toxic effects encountered and anticipated in clinical investigation and practice with antiangiogenic agents in patients with ovarian cancer, with particular focus on potential management strategies.
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Affiliation(s)
- Rebecca L Stone
- Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA
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Flaig TW, Kim FJ, La Rosa FG, Breaker K, Schoen J, Russ PD. Colonic pneumatosis and intestinal perforations with sunitinib treatment for renal cell carcinoma. Invest New Drugs 2008; 27:83-7. [PMID: 18563296 DOI: 10.1007/s10637-008-9146-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 05/16/2008] [Indexed: 12/19/2022]
Affiliation(s)
- Thomas W Flaig
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver School of Medicine, Mail Stop 8117, P.O. Box 6511, Aurora, CO, USA.
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Lenz HJ. First-line combination treatment of colorectal cancer with hepatic metastases: Choosing a targeted agent. Cancer Treat Rev 2008; 34 Suppl 2:S3-7. [DOI: 10.1016/s0305-7372(08)70002-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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