title: Gastrointestinal perforation during regorafenib administration in a case with hepatic metastases of colon cancer.
abstract: Although common side effects of regorafenib include hand-and-foot syndrome and diarrhoea, the incidence of gastrointestinal perforation is reportedly unknown. We describe our experience with the case of a 65-year-old woman treated with regorafenib as a third-line therapy for progressive caecal cancer with multiple hepatic metastases after 4 and 6 courses of systemic mFOLFOX6 + bevacizumab (BV) and FOLFIRI + BV chemotherapy, respectively. The patient used regorafenib for 32 days but visited our hospital with abdominal pain during the second course. She was diagnosed with acute appendicitis and treated conservatively with antibiotics. The abdominal findings did not improve, and a computed tomography evaluation on day 4 of hospitalization revealed free air lateral to the caecal tumour, liver surface, and epigastric region. The patient underwent same-day emergency surgery based on a diagnosis of gastrointestinal perforation with generalized peritonitis. Upon observing digestive fluid leakage into the peri-ileocaecal area and a 5-mm perforation in the appendix, the patient was diagnosed with peritonitis due to gastrointestinal perforation. Ileocaecal resection with D2 debridement was performed, and a colostomy was opened into the ileum and ascending colon. We conclude that our patient developed gastrointestinal perforation during regorafenib therapy and note that clinicians should be aware of this possible complication in patients with a history of prior treatment with BV.
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Kenichi
authors.identifier: http://orcid.org/0000-0002-3001-6981
authors.initials: K
authors.lastname: Ogata
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Umezaki
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Yagi
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Ogawa
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ozaki
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ikuta
authors.affiliation: a Department of Surgery , Saiseikai Kumamoto Hospital , Kumamoto , Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Doi
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000139:chemically induced*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology; D010671:Phenylurea Compounds / Q000008:administration & dosage* / Q000009:adverse effects*; D011725:Pyridines / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D010671:Phenylurea Compounds; D011725:Pyridines; C559147:regorafenib
keywords: Bevacizumab; Colon cancer; Gastrointestinal perforation; Regorafenib