Bevacizumab-Associated Thrombotic Microangiopathy Treated with Eculizumab: A Case Report

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorPADILHA, Wallace Stwart Carvalho
dc.contributor.authorCESAR, Bruno Nogueira
dc.contributor.authorPACHECO, Samara Theodoro
dc.contributor.authorSOUSA, Alessandra Alves De
dc.contributor.authorLEDESMA, Felipe Lourenco
dc.contributor.authorMALHEIROS, Denise Maria Avancini Costa
dc.contributor.authorTEIXEIRA, Marcela Crosara Alves
dc.date.accessioned2023-10-30T14:40:12Z
dc.date.available2023-10-30T14:40:12Z
dc.date.issued2023
dc.description.abstractPatient: 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.eng
dc.description.indexMEDLINE
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.identifier.citationAMERICAN JOURNAL OF CASE REPORTS, v.24, article ID e940906, 7p, 2023
dc.identifier.doi10.12659/AJCR.940906
dc.identifier.eissn1941-5923
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/56186
dc.language.isoeng
dc.publisherINT SCIENTIFIC INFORMATION, INCeng
dc.relation.ispartofAmerican Journal of Case Reports
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright INT SCIENTIFIC INFORMATION, INCeng
dc.subjectAtypical Hemolytic Uremic Syndromeeng
dc.subjectBevacizumabeng
dc.subjectEculizumabeng
dc.subjectAcute Kidney Injuryeng
dc.subjectThrombotic Microangiopathieseng
dc.subject.othercase serieseng
dc.subject.wosMedicine, General & Internaleng
dc.titleBevacizumab-Associated Thrombotic Microangiopathy Treated with Eculizumab: A Case Reporteng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.author.externalPADILHA, Wallace Stwart Carvalho:Hosp DFStar Rede DOr Sao Luiz, Dept Nephrol, Brasilia, DF, Brazil
hcfmusp.author.externalCESAR, Bruno Nogueira:Hosp DFStar Rede DOr Sao Luiz, Dept Nephrol, Brasilia, DF, Brazil
hcfmusp.author.externalPACHECO, Samara Theodoro:Hosp DFStar Rede DOr Sao Luiz, Dept Oncol, Brasilia, DF, Brazil
hcfmusp.author.externalSOUSA, Alessandra Alves De:Hosp DFStar Rede DOr Sao Luiz, Dept Nephrol, Brasilia, DF, Brazil
hcfmusp.author.externalTEIXEIRA, Marcela Crosara Alves:Hosp DFStar Rede DOr Sao Luiz, Dept Oncol, Brasilia, DF, Brazil
hcfmusp.citation.scopus0
hcfmusp.contributor.author-fmusphcFELIPE LOURENCO LEDESMA
hcfmusp.contributor.author-fmusphcDENISE MARIA AVANCINI COSTA MALHEIROS
hcfmusp.description.articlenumbere940906
hcfmusp.description.volume24
hcfmusp.origemWOS
hcfmusp.origem.pubmed37644709
hcfmusp.origem.scopus2-s2.0-85168961218
hcfmusp.origem.wosWOS:001060523400001
hcfmusp.publisher.cityMELVILLEeng
hcfmusp.publisher.countryUSAeng
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hcfmusp.scopus.lastupdate2024-05-17
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relation.isAuthorOfPublication.latestForDiscovery791e979a-1a21-403e-8879-b23137919a11
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