title: Hemorrhagic pseudoaneurysm in a patient receiving aflibercept for metastatic thyroid cancer.
abstract: BACKGROUND
  Agents such as aflibercept, which target the angiogenic pathway, are of great interest as candidates for the management of metastatic differentiated thyroid cancer. Here, we report a patient who developed a hemorrhagic abdominal pseudoaneurysm shortly after being started on this drug.
  
  
  METHODS
  The patient was a 67-year-old woman being treated with single agent aflibercept (VEGF-Trap) for metastatic thyroid cancer. She had no history of intra-abdominal pathology or vascular disease but had been previously treated with sorafenib. Twelve days after receiving her second dose of aflibercept, she developed vague abdominal pain, which increased in severity and was accompanied by nausea and vomiting. Her symptoms progressed along with a decline in her hematocrit and signs of internal hemorrhaging. An angiogram identified an occluded celiac artery with increased collaterals and a bleeding pseudoaneurysm in the inferior pancreaticoduodenal artery. After the pseudoaneurysm was coiled, the patient stabilized.
  
  
  CONCLUSIONS
  Anti-angiogenic agents, usually well tolerated, can disrupt the delicate balance of normal endothelium, leading to hemorrhagic and thrombotic complications. The hemorrhage of aberrant vasculature should be included in the differential diagnosis in patients presenting with vague complaints while being treated with anti-angiogenic agents.
authors.affiliation: Head and Neck Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. baxis@mskcc.org
authors.forename: Shrujal S
authors.initials: SS
authors.lastname: Baxi
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Sherman
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Kelly
authors.forename: Karen T
authors.initials: KT
authors.lastname: Brown
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Dematteo
authors.forename: David G
authors.initials: DG
authors.lastname: Pfister
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000150:complications / Q000209:etiology*; D020533:Angiogenesis Inhibitors / Q000494:pharmacology; D000792:Angiography / Q000379:methods; D004386:Duodenum / Q000098:blood supply; D005260:Female; D006400:Hematocrit; D006470:Hemorrhage / Q000150:complications / Q000209:etiology*; D006801:Humans; D009362:Neoplasm Metastasis; D010179:Pancreas / Q000098:blood supply; D040262:Receptors, Vascular Endothelial Growth Factor; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D013964:Thyroid Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor