Reactions 1415 - 18 Aug 2012

SAntineoplastics

Ileus: case reportA 64-year-old woman with metastatic colorectal cancer

developed ileus as a result of rapid tumour necrosis causingcicatricial contraction and stenosis, during chemotherapywith bevacizumab and mFOLFOX6 (oxaliplatin, calciumlevofolinate and fluorouracil).

The woman was hospitalised and scheduled to receivethe following chemotherapy regimen: an IV drip ofbevacizumab 280mg, an IV drip of oxaliplatin 130mg, an IVdrip of calcium levofolinate 300mg, a rapid IV injection offluorouracil 600mg, and a constant infusion of fluorouracil3600mg. All drugs were administered on the first day, andone course was repeated every 2 weeks. She received herfirst and second courses on day 9 and 23, respectively;however, ileus developed on d30. Her third course wasscheduled on day 38, and it was noted that she had nobowel movement for several days; ileus was confirmed byabdominal radiography and CT.

The woman was hospitalised and underwent a transanalileus tube insertion, which temporarily improved theinflammation. Sigmoidectomy was performed onday 43 due to worsening of abdominal findings includingabdominal distension and tenderness. An analysis of theresected specimen revealed stenosis, and a markedlyshrunk and hardened tumour site. Histopathology showeddestruction of the normal colonic wall structure in the ulcersite, inflammatory cell infiltration, fibrosis and bleeding,with necrosis of more than 2/3 of the cancer tissue. Herpostoperative course was unremarkable, andmFOLFOX6 therapy was resumed, without bevacizumab,on day 66. Two courses were administered, andbevacizumab was subsequently resumed.

Author comment: We experienced a case of response tobevacizumab + FOLFOX combination therapy, with rapidnecrosis of the primary tumour causing cicatricial contractionand stenosis leading to ileus.Takanashi K, et al. A case of advanced primary colorectal carcinoma accompaniedby liver metastasis in which ileus developed due to marked fibrosis with cicatricialformation in primary colorectal cancer treated by chemotherapy includingbevacizumab. Nihon Shokakibyo Gakkai Zasshi / Japanese Journal ofGastroenterology 109: 766-773, No. 5, May 2012 [Japanese; summarised from atranslation] - Japan 803075551

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Reactions 18 Aug 2012 No. 14150114-9954/10/1415-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved