A Rare Hematological Adverse Event Induced by Bevacizumab: Severe Thrombocytopenia - 25/07/12
, Olivier Mir, MD, PhDc, MPH b, c, Catherine Brezault, MD, MSc a, Géraldine Perkins, MD, PhDc a, b, Marion Dhooge, MD a, François Goldwasser, MD, PhD a, c, Stanislas Chaussade, MD, PhD a, b
Requests for reprints should be addressed to Romain Coriat, MD, PhDc, Centre for Research on Angiogenesis Inhibitors (CERIA), Medical Oncology Unit, Université Paris Descartes, AP-HP, 27 rue du faubourg Saint Jacques, Paris F75014, FranceAbstract |
Background |
Bevacizumab, a monoclonal antibody to vascular endothelial growth factor-A, is approved for the treatment of various malignancies, and its hematological toxicities are considered infrequent.
Methods |
A colorectal cancer patient receiving chemotherapy (5-fluorouracil and oxaliplatin) plus bevacizumab developed acute, severe thrombocytopenia. We postulated that this thrombocytopenia could be directly triggered by bevacizumab.
Results |
A man with stage IV colorectal cancer and synchronous liver metastasis had received 10 cycles of FOLFOX plus bevacizumab (5 mg/kg) without significant hematological toxicity. Due to thrombocytopenia, oxaliplatin was withdrawn after cycle 11. On cycle 12, shortly after bevacizumab infusion and before 5-fluorouracil infusion, the patient developed fever, lower limbs purpura, grade 1 proctorrhagia, and epistaxis. Platelets had decreased from 105,000/mm3 to 3000/mm3 within 1 hour after bevacizumab infusion. Flow cytometry identified platelet-associated immunoglobulins. Despite 2 apheresis-derived platelet transfusions, oral corticotherapy, and gamma globulin infusions, thrombocytopenia persisted, but was finally successfully treated with a peptibody thrombopoietin mimetic, which was introduced 28 days after the last bevacizumab infusion.
Conclusions |
Clinicians should keep in mind that bevacizumab can induce acute and potentially severe immune-mediated thrombocytopenia.
El texto completo de este artículo está disponible en PDF.Keywords : Angiogenesis inhibitors, Bevacizumab, Cancer, Immune-thrombocytopenia, Romiplostim, VEGF-A
Esquema
| Funding: None. |
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| Conflict of Interest: Dr Mir and Dr Coriat have acted as paid consultants for Roche; Prof Goldwasser has acted as a paid consultant for Amgen. Other authors have no conflict of interest to declare. |
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| Authorship: All authors had access to the data and a role in writing the manuscript. |
Vol 125 - N° 8
P. 828-830 - août 2012 Regresar al número
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