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Nonaka K, Kawase K, Takagi K, Takatsu Y, Maniwa K, Takao C, Komura M, Mushika Y, Takeuchi N, Kato T, Kusakabe M, Kondo M. Development of Fournier's gangrene after chemotherapy for the recurrence of testicular cancer despite the absence of anorectal lesions: A case report. Medicine (Baltimore) 2024; 103:e38688. [PMID: 39058861 PMCID: PMC11272336 DOI: 10.1097/md.0000000000038688] [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: 03/09/2024] [Accepted: 06/03/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Fournier's gangrene usually occurs when a specific bacterium intrudes into soft tissue, causing a wound or tumor. We encountered a patient with Fournier's gangrene due to severe myelosuppression after chemotherapy, despite the absence of an initial lesion on the anus and rectum. CASE PRESENTATION A 54-year-old man with a left testicular cancer recurrence had undergone chemotherapy. He had asymptomatic hepatitis and high hepatitis B virus DNA levels, which were normalized by administering tenofovir alafenamide fumarate. Twelve days after the start of chemotherapy, he complained of severe pain around the anus. The following day, he went into septic shock. Visual inspection showed dark purple skin discoloration on the left side of the anus. Laboratory data revealed severe neutropenia. Computed tomography showed a high density of soft tissue on the left side of the anus and gas bubbles in the left femoral ring. We diagnosed the patient with Fournier's gangrene due to a severe immunosuppressive state resulting from chemotherapy. We emergently removed necrotic tissue to the fullest extent possible. However, because the patient was in severe sepsis status, careful management in the intensive care unit was required for 32 days. After the first emergency operation, we performed several additional excisions. Finally, 391 days after the initial surgery, the patient was discharged from our hospital. The tumor has not recurred, and he is under outpatient observation in the urology department. CONCLUSION Fournier's gangrene should be considered in patients who are in a severe myelosuppressive state due to chemotherapy, have normal hepatitis B virus DNA levels but high hepatitis B surface antigen after tenofovir administration, complain of severe pain in the perianal area, and have a dark purple skin discoloration around the anus, despite having no initial anorectal lesions.
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Affiliation(s)
- Kenichi Nonaka
- Department of Digestive Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Kota Kawase
- Department of Urology, Daiyukai Daiichi Hospital, Ichinomiya, Aichi, Japan
| | - Kimiaki Takagi
- Department of Urology, Daiyukai Daiichi Hospital, Ichinomiya, Aichi, Japan
| | - Yuta Takatsu
- Department of Digestive Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Koji Maniwa
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Chika Takao
- Department of Digestive Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Minoru Komura
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Yoshinori Mushika
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Noriyuki Takeuchi
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Toshio Kato
- Department of Pathology, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Mitsuhiko Kusakabe
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Mitsutaka Kondo
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
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Rakusic Z, Krpan AM, Sjekavica I. Fulminant Fournier's gangrene in a patient with gastric cancer treated with ramucirumab and paclitaxel. Ther Adv Drug Saf 2020; 11:2042098620946556. [PMID: 32874533 PMCID: PMC7436778 DOI: 10.1177/2042098620946556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/02/2020] [Indexed: 11/16/2022] Open
Abstract
Fournier's gangrene (FG) is an uncommon form of necrotizing fasciitis, localized on the external genital organs, perianal region, and abdominal wall, accompanied by thrombosis of the feeding arteries, leading to gangrene of the skin and subcutaneous tissue, with manifestations of rapid clinical progression and multiple organ failure. Ramucirumab is a recombinant human immunoglobulin G1 monoclonal antibody that binds to the extracellular binding domain of vascular endothelial growth factor receptor-2 (VEGFR-2) and prevents the binding of all VEGFR ligands. The literature describes bevacizumab, aflibercept, and regorafenib associated with FG in patients with colorectal cancer. According to our knowledge this is the first report of FG possibly related to ramucirumab in a patient with gastric cancer. If not recognized in time, it can lead to fatal complications.
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Affiliation(s)
- Zoran Rakusic
- Department of Oncology, University Hospital Centre Zagreb; School of Medicine, University of Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Ana Misir Krpan
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivica Sjekavica
- Department of Diagnostic and Interventional Radiology, University Hospital Centre, Zagreb, Croatia
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Barone M, Grani G, Ramundo V, Garritano T, Durante C, Falcone R. Fournier's gangrene during lenvatinib treatment: A case report. Mol Clin Oncol 2020; 12:588-591. [PMID: 32337042 DOI: 10.3892/mco.2020.2031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/21/2020] [Indexed: 01/22/2023] Open
Abstract
Fournier's gangrene is a rare and severe complication reported in patients with cancer treated with antiangiogenic drugs, most frequently with bevacizumab. The present report describes the case of an 80-year-old man with radioactive iodine-refractory metastatic thyroid cancer treated with lenvatinib (an oral multikinase inhibitor with antiangiogenic properties) who developed Fournier's gangrene in the absence of other known risk factors. To the best of our knowledge, this is the first case described during treatment with lenvatinib. The condition was likely due to a perturbation of vascular endothelial cells of the skin due to the inhibition of VEGF/VEGFR signaling. Fournier's gangrene may be a class effect of antiangiogenic treatment that clinicians should be aware of, as early diagnosis and treatment are associated with an improved outcome.
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Affiliation(s)
- Martina Barone
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
| | - Tiziana Garritano
- Department of Surgical Sciences, Sapienza University of Rome, I-00161 Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
| | - Rosa Falcone
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
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Necrotizing fasciitis associated with sorafenib treatment. IDCases 2019; 18:e00611. [PMID: 31428562 PMCID: PMC6695268 DOI: 10.1016/j.idcr.2019.e00611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 12/04/2022] Open
Abstract
There are only few case reports available on NF resulting from molecular targeted therapy. This is the first case report of sorafenib-associated NF. Clinicians should be aware of this possible adverse effect of molecular targeted therapy.
We present here a case of extensive necrotizing fasciitis during sorafenib treatment in a patient with HBV-related hepatocellular carcinoma. Despite emergent extensive surgical debridement, the patient's clinical status progressive worsened until interruption of sorafenib therapy. The patient was successfully treated with temporal interruption of sorafenib therapy. To our knowledge, this is the first case report of sorafenib-associated necrotizing fasciitis. Given the life-threatening nature of the infection and the necessity for urgent intervention, clinicians should be aware of this possible adverse effect of tyrosine kinase inhibitors.
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Nomura T, Yamakawa M, Shimaoka T, Hirai T, Koizumi N, Maruyama K, Utoguchi N. Development of Dendritic Cell-Based Immunotherapy Targeting Tumor Blood Vessels in a Mouse Model of Lung Metastasis. Biol Pharm Bull 2019; 42:645-648. [PMID: 30930423 DOI: 10.1248/bpb.b18-00737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Tumor blood vessels supply cancer tissues with oxygen and nutrients, and it was therefore believed that inhibition of angiogenesis would induce tumor regression. In fact, the situation is complicated by the presence of normal blood vessels in cancer tissues such as carcinomas and sarcomas as well as abnormal vessels. Here, we describe the development of a dendritic cell (DC)-based immunotherapy which targets tumor endothelial cells (TECs) rather than normal endothelial cells (ECs) or cancer cells themselves. After density gradient centrifugation, the TEC-rich fraction from lungs invaded by B16 melanoma cells was separated from the endothelial cell (EC)-rich fraction on the basis of positivity for angiotensin-converting enzyme (ACE) activity. Prophylactic vaccination with DCs pulsed with lysates of TECs isolated from lungs with metastases significantly suppressed lung metastasis in this B16/BL6 mouse melanoma model. This suggests that DC-based vaccine therapy targeting TECs in cancers tissue could show promise as an effective therapy for distant metastasis.
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Affiliation(s)
- Tetsuya Nomura
- Department of Pharmaceutics and Biopharmaceutics, Showa Pharmaceutical University.,Faculty of Pharma-Sciences, Teikyo University
| | - Makie Yamakawa
- Department of Pharmaceutics and Biopharmaceutics, Showa Pharmaceutical University
| | | | - Takamasa Hirai
- Department of Pharmaceutics and Biopharmaceutics, Showa Pharmaceutical University
| | - Naoya Koizumi
- Department of Pharmaceutics and Biopharmaceutics, Showa Pharmaceutical University
| | | | - Naoki Utoguchi
- Department of Pharmaceutics and Biopharmaceutics, Showa Pharmaceutical University.,Faculty of Pharma-Sciences, Teikyo University
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Gonzaga-López A, Muñoz-Rodriguez J, Ruiz-Casado A. Necrotising fasciitis in a patient treated with FOLFIRI-aflibercept for colorectal cancer: a case report. Ann R Coll Surg Engl 2017; 99:e225-e226. [PMID: 28768426 PMCID: PMC5696931 DOI: 10.1308/rcsann.2017.0143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Anti-angiogenics have become an important part of the treatment of several types of tumours such as ovarian, breast, lung and colorectal cancer. Necrotising fasciitis has been reported with bevacizumab but no cases have been reported with aflibercept, ramucirumab or regorafenib in patients with colorectal cancer. Necrotising fasciitis is a rare complication affecting one in 5000 bevacizumab users. We report the case of a 64-year-old man with stage IV rectosigmoid cancer under treatment with folinic acid, fluorouracil and irinotecan (FOLFIRI) and aflibercept, who developed a Fournier’s gangrene.
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Affiliation(s)
| | | | - A Ruiz-Casado
- Medical oncologist at Puerta de Hierro Majadahonda University Hospital
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A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report. Surg Case Rep 2017; 3:74. [PMID: 28550641 PMCID: PMC5446431 DOI: 10.1186/s40792-017-0350-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/18/2017] [Indexed: 12/20/2022] Open
Abstract
Background Fournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks. Emergency surgical debridement of necrotic tissue is crucial, and secondary surgery to resect tumors is necessary for wound healing. However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound. The management of pelvic exenteration for rectal cancer with Fournier gangrene has not yet been established. We herein describe the use of a fascia lata free flap in pelvic exenteration for rectal cancer with Fournier gangrene. Case presentation A 66-year-old male who had undergone colostomy for large bowel obstruction due to advanced rectal cancer and continued chemotherapy was referred to our hospital for Fournier gangrene resulting from chemotherapy. Emergency surgical debridement was performed, and the infectious wound around the rectal cancer was treated with intravenous antibiotic agents postoperatively. However, the tumor was exposed by the wound, and exudate persisted. Pelvic exenteration was performed due to tumor infiltration into the bladder and prostate. Tumor resection resulted in a defect in the pelvic floor. A fascia lata free flap (15 × 9 cm) obtained from the left thigh was fixed to the edge of the peritoneum and ileal conduit to close the defect in the pelvic floor and prevent small bowel herniation into the resected space. There was no intraabdominal inflammation or bowel obstruction postoperatively, and outpatient chemotherapy was continued. Conclusions Surgical repair with a fascia lata free flap to close the defect in the pelvic floor led to a good clinical outcome for pelvic exenteration in a patient with Fournier gangrene due to advanced rectal cancer.
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Kadioglu O, Efferth T. Peptide aptamer identified by molecular docking targeting translationally controlled tumor protein in leukemia cells. Invest New Drugs 2016; 34:515-21. [DOI: 10.1007/s10637-016-0339-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/04/2016] [Indexed: 11/29/2022]
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Ueshima J, Maeda K, Wakabayashi H, Nishioka S, Nara S, Nakatani H. Availability of Early, Intensive, and Continuous Nutrition Management for Fournier's Gangrene with Rectal Cancer: A Case Report. J Acad Nutr Diet 2015; 116:909-16. [PMID: 26586533 DOI: 10.1016/j.jand.2015.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Indexed: 12/28/2022]
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Ugai T, Norizuki M, Mikawa T, Ohji G, Yaegashi M. Necrotizing fasciitis caused by Haemophilus influenzae type b in a patient with rectal cancer treated with combined bevacizumab and chemotherapy: a case report. BMC Infect Dis 2014; 14:198. [PMID: 24725844 PMCID: PMC3995739 DOI: 10.1186/1471-2334-14-198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, necrotizing fasciitis has been reported in patients treated with bevacizumab, usually secondary to wound healing complications, gastrointestinal perforations, or fistula formation. The risk of invasive Haemophilus influenzae type b infection is significantly increased in immunocompromised hosts. However, necrotizing fasciitis due to Haemophilus influenzae type b in a patient treated with combined bevacizumab and chemotherapy has not been previously reported. CASE PRESENTATION A 59-year-old woman was admitted to the intensive care unit after sudden onset of fever, chills, and right thigh pain. She received chemotherapy with fluorouracil, irinotecan, and bevacizumab for colon cancer 10 days prior to admission. The advancing erythematous margin and her worsening clinical condition prompted us to suspect necrotizing fasciitis and consult the orthopedics department for a fascia biopsy and debridement. Surgical exploration revealed a murky dishwater-colored pus exudate from the incision site and the lack of a shiny appearance of the fascia that also suggested necrotizing fasciitis. After 2 days, the final results of the blood and exudate cultures confirmed the presence of Haemophilus influenzae type b. A diagnosis of necrotizing fasciitis due to Haemophilus influenzae type b was made. The patient required recurrent surgical debridement and drainage, but she recovered from the septic shock. CONCLUSIONS We report a case of necrotizing fasciitis due to Haemophilus influenzae type b in a patient without injury and with rectal cancer treated with combined bevacizumab and chemotherapy. Physicians should consider invasive Haemophilus influenzae type b disease in the presence of necrotizing fasciitis in patients treated with this combined treatment modality.
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Affiliation(s)
- Tomotaka Ugai
- Division of General Internal Medicine and Infectious Disease, Department of Medicine, Kameda Medical Center, Kamogawa-shi, Chiba 296-8601, Japan.
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Piszczek J, Dalton B, Peters T, Ruether D, Urbanski S. Extensive necrotizing fasciitis associated with sunitinib therapy. Clin Genitourin Cancer 2014; 12:e47-9. [PMID: 24445249 DOI: 10.1016/j.clgc.2013.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 10/20/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Jolanta Piszczek
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada; Vancouver Island Health Authority, Victoria, Canada.
| | - Bruce Dalton
- Pharmacy Services, Alberta Health Services, Foothills Medical Centre, Calgary, Canada
| | - Tess Peters
- Department of Dermatology, University of Calgary, Calgary, Canada
| | - Dean Ruether
- Department of Oncology, University of Calgary, Calgary, Canada
| | - Stefan Urbanski
- Department of Pathology, University of Calgary, Calgary, Canada
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Pavlidis ET, Pavlidis TE. Role of bevacizumab in colorectal cancer growth and its adverse effects: A review. World J Gastroenterol 2013; 19:5051-5060. [PMID: 23964138 PMCID: PMC3746376 DOI: 10.3748/wjg.v19.i31.5051] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/07/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
Angiogenesis affects both wound healing and malignant cell growth through nutrients and oxygen. Vascular endothelial growth factor (VEGF) is the most important element involved in this complex process. Inhibition of VEGF influences angiogenesis and may restrict tumor growth and metastatic ability. Modern anti-angiogenic therapy is based on this theory. Bevacizumab is a recombinant humanized monoclonal antibody (immunoglobulin G1) which binds with VEGF-A forming a large molecule. It can not be bound with VEGF tyrosine kinase receptors preventing VEGF-A incorporation; thus its activity is inhibited inducing blockage of VEGF-mediated angiogenesis. Bevacizumab, in combination with chemotherapy or other novel targeted therapeutic agents, is currently used more frequently in clinical practice, mainly for managing advanced colorectal cancer. It is also used for managing other malignancies, such as breast cancer, pancreatic cancer, prostate cancer, non small-cell lung cancer, metastatic renal carcinoma and ovarian tumors. Although it is generally considered a safe treatment, there are reports of some rare side effects which should be taken into account. Recent experiments in rats and mice show promising results with a wider therapeutic range.
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Shamloo BK, Chhabra P, Freedman AN, Potosky A, Malin J, Weiss Smith S. Novel adverse events of bevacizumab in the US FDA adverse event reporting system database: a disproportionality analysis. Drug Saf 2012; 35:507-18. [PMID: 22612854 DOI: 10.2165/11597600-000000000-00000] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bevacizumab is the first in its class, vascular endothelial growth factor (VEGF) inhibitor that was initially approved by the US FDA in 2004 for the treatment of metastatic colon cancer and other solid tumors. Preapproval clinical trials, particularly for oncology drugs, are limited in their ability to detect certain adverse effects and, therefore, the FDA and pharmaceutical sponsors collect and monitor reports of adverse events (AEs) following approval. OBJECTIVE The purpose of this study was to screen the FDA's Adverse Event Reporting System (AERS) database for novel AEs that may be attributed to bevacizumab. METHODS The FDA AERS database was used to identify all AE reports for bevacizumab from February 2004 to September 2009. Disproportionality analysis was conducted for bevacizumab against all other drugs in the background by setting statistical significance at proportional reporting ratio (PRR) ≥2, observed case count ≥3 and chi-square ≥4. Subsequent clinical evaluation was performed to determine the clinical relevance of the findings and to group related events. RESULTS A total of 523 Preferred Terms (PTs) were disproportionally reported; following clinical review 63 (12%) were found to be both unlabelled and of clinical importance. These PTs were grouped into 15 clinical disorder groups. Among the clinical disorders, electrolyte abnormalities had the greatest number of reports (n = 426) followed by cardiovascular events (n = 421), gastrointestinal events (n = 345), nervous system disorders (n = 106) and pneumonitis (n = 96). On sensitivity analysis, a number of clinically important unlabelled disorders, such as necrotizing fasciitis, vessel wall disorders, arrhythmia and conduction disorder and autoimmune thrombocytopenia still met the statistical significance criteria. CONCLUSIONS During the study period, out of 12 010 AE reports mentioning bevacizumab, it was listed as the suspect drug in 94.2% of the reports. Our disproportionality analysis identified many events that are already recognized as AEs of bevacizumab, but it also identified a number of clinically important unlabelled terms, which if confirmed in future studies would have potential implications for use of bevacizumab in clinical practice.
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Affiliation(s)
- Behrooz K Shamloo
- University of Nevada School of Medicine-Nevada Cancer Institute, Las Vegas, NV, USA
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Pavlidis ET, Ballas KD, Psarras K, Symeonidis NG, Koliakos G, Kouzi-Koliakos K, Rafailidis SF, Pavlidis TE, Marakis GN, Sakantamis AK. Intraperitoneal administration of bevacizumab intraoperatively does not affect abdominal wound healing in rats. Eur Surg Res 2011; 47:45-51. [PMID: 21606651 DOI: 10.1159/000327970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 03/31/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bevacizumab is a monoclonal antibody targeted at vascular endothelial growth factor (VEGF) to treat advanced colorectal cancer as well as other malignancies, but the ideal time point for its administration in patients scheduled for surgery is not well defined due to serious concerns regarding possible side effects on wound healing. Therefore, we conducted an experimental study in rats to clarify this issue. METHODS Four groups of 10 Wistar rats each underwent a 4-cm midline laparotomy and closure of the wound in 2 layers. In the treatment groups (A and B), bevacizumab (Avastin(®)) received a single dose of 5 mg/kg i.p., and an equal amount of saline was given to the control groups (C and D). Groups A and C were sacrificed on the 7th postoperative day, and groups B and D on the 14th postoperative day. Wounds were inspected by two independent observers upon sacrifice and results were recorded; wound tissues were sent for histology to assess the degree of fibrosis and measurement of tissue hydroxyproline levels. Serum levels of endothelin-1, C-reactive protein, pro-oxidant/antioxidant balance and carbonylated proteins were also determined. For statistical analysis, the Mann-Whitney U test was used. RESULTS Wound healing did not differ among groups both on the 7th and the 14th postoperative days, and there was also no significant difference regarding the degree of inflammation, fibroblast proliferation and collagen synthesis, as well as hydroxyproline and biochemical marker levels among the groups. CONCLUSIONS Intraperitoneal bevacizumab administered intraoperatively does not significantly affect abdominal wound healing in rats.
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Affiliation(s)
- E T Pavlidis
- Second Propaedeutic Department of Surgery, Hippocration Hospital, Thessaloniki, Greece
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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