Bevacizumab-Associated Thrombotic Microangiopathy Treated with Eculizumab: A Case Report
Carregando...
Citações na Scopus
0
Tipo de produção
article
Data de publicação
2023
Título da Revista
ISSN da Revista
Título do Volume
Editora
INT SCIENTIFIC INFORMATION, INC
Autores
PADILHA, Wallace Stwart Carvalho
CESAR, Bruno Nogueira
PACHECO, Samara Theodoro
SOUSA, Alessandra Alves De
TEIXEIRA, Marcela Crosara Alves
Citação
AMERICAN JOURNAL OF CASE REPORTS, v.24, article ID e940906, 7p, 2023
Resumo
Patient: Female, 64-year-old Final Diagnosis: Bevacizumab-associated thrombotic microangiopathy Symptoms: Microangiopathic hemolytic anemia and acute kidney injury Clinical Procedure: - Specialty: Nephrology Objective: Rare disease Background: Bevacizumab is an approved targeted therapy for metastatic cancer treatment. It can have adverse effects on multiple organs. Despite its low incidence, thrombotic microangiopathy (TMA) is the most severe complication. TMA has been associated with complement dysregulation, and treatment with eculizumab can be effective, despite the paucity of literature on eculizumab therapy for bevacizumab-associated TMA. To date, 10 cases have been reported, with less than half of them including a kidney biopsy. We present a new case of bevacizumab-associated TMA successfully treated with eculizumab, along with kidney biopsy records and an overview of mechanisms underlying TMA development in bevacizumab-treated patients. Case Report: A female patient diagnosed with metastatic breast cancer who was treated with bevacizumab in conjunction with chemotherapy was admitted to the hospital for acute kidney injury requiring hemodialysis, microangiopathic hemolytic anemia, and thrombocytopenia. TMA was diagnosed and was later confirmed by a kidney biopsy. Primary causes for TMA, such as ADAMTS13 deficiency and shiga toxin associated hemolytic-uremic syndrome, were ruled out, and the patient's condition was ultimately found to be triggered by exposure to bevacizumab. After discontinuing bevacizumab and receiving 4 weekly doses of eculizumab, kidney function and hematological parameters improved. Conclusions: Bevacizumab-associated TMA can be reversed or attenuated in some patients with the use of eculizumab (inhibiting complement system overactivation), possibly reducing time to recovery, with fewer long-term sequelae. This additional case encourages future clinical trials to evaluate the safety and efficacy of eculizumab in cases of TMA associated with bevacizumab.
Palavras-chave
Atypical Hemolytic Uremic Syndrome, Bevacizumab, Eculizumab, Acute Kidney Injury, Thrombotic Microangiopathies
Referências
- Al Ustwani O, 2014, J GASTROINTEST ONCOL, V5, pE30, DOI 10.3978/j.issn.2078-6891.2013.042
- Eremina V, 2008, NEW ENGL J MED, V358, P1129, DOI 10.1056/NEJMoa0707330
- Estrada CC, 2019, J AM SOC NEPHROL, V30, P187, DOI 10.1681/ASN.2018080853
- Genest DS, 2023, AM J KIDNEY DIS, V81, P591, DOI 10.1053/j.ajkd.2022.10.014
- Hausberg M, 2019, CASE REP ONCOL, V12, P1, DOI 10.1159/000495031
- Hilburg R, 2021, CLIN NEPHROL, V96, P51, DOI 10.5414/CN110443
- Inozu M, 2022, PEDIAT HEMATOL ONCOL, V4, P169
- Keir LS, 2017, J CLIN INVEST, V127, P199, DOI 10.1172/JCI86418
- Kopp A, 2012, BIOMOLECULES, V2, P46, DOI 10.3390/biom2010046
- Kroll J, 1998, BIOCHEM BIOPH RES CO, V252, P743, DOI 10.1006/bbrc.1998.9719
- Perazella MA, 2015, KIDNEY INT, V87, P909, DOI 10.1038/ki.2015.30
- Pfister F, 2018, HISTOPATHOLOGY, V73, P990, DOI 10.1111/his.13716
- Usui J, 2014, HUM PATHOL, V45, P1918, DOI 10.1016/j.humpath.2014.05.015
- Vakiti A, 2019, J ONCOL PHARM PRACT, V25, P1011, DOI 10.1177/1078155218774895
- Viscardi G, 2019, ESMO OPEN, V4, DOI 10.1136/esmoopen-2019-000551
- Weitz IC, 2018, BRIT J HAEMATOL, V183, P136, DOI 10.1111/bjh.14910