title: Late anastomotic colonic dehiscence due to antiangiogenic treatment, a specific drug-class complication requiring specific treatment: an example of pazopanib complication.
abstract: Bevacizumab, a recombinant humanized monoclonal antibody against vascular endothelial growth factor (VEGF), was the first angiogenesis inhibitor approved for the first-line treatment of metastatic colorectal cancer in combination with intravenous fluorouracil-based chemotherapy. Two major cohort studies--BRiTE and BEAT--reported a 2% incidence of bowel perforation, which remains a rare, but serious, complication of bevacizumab treatment. Late anastomotic complications, arising > 3 months after surgery, are emerging occurrences that may be associated with bowel perforation. We report here on such a case caused by pazopanib, a new antiangiogenic agent, and also include a review of the published cases in the literature (n = 23) and an analysis of their management. Proctectomy was the initial surgery in 17 patients (74%) with rectal cancer, and 13 of these patients had undergone adjuvant radiation prior to surgery. The majority (84%) of the complications occurred with antiangiogenic treatment after a mean number of four cycles. Patients' management was invariably associated with withdrawal of the antiangiogenic agent, together with conservative treatment in 14 patients (66%).
authors.affiliation: Service de chirurgie digestive, hôpital Lariboisière, AP-HP, université Paris-Diderot-Paris-7, 2, rue Amboise-Paré, 75010 Paris, France.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Eveno
authors.forename: Christine
authors.initials: C
authors.lastname: le Maignan
authors.forename: Philippe
authors.initials: P
authors.lastname: Soyer
authors.forename: Marine
authors.initials: M
authors.lastname: Camus
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barranger
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D003082:Colectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007191:Indazoles; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects*; D058994:Salpingectomy; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000139:chemically induced* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D007191:Indazoles; D011743:Pyrimidines; D013449:Sulfonamides; C516667:pazopanib