Antineoplastic agents and thrombotic microangiopathy

Abstract

Thrombotic microangiopathy is an uncommon but reported adverse effect of a variety of antineoplastic drugs, including chemotherapy agents such as mitomycin C and gemcitabine, and newer targeted agents such as the vascular endothelial growth factor inhibitors. We present a review of thrombotic microangiopathy associated with antineoplastic agents and its implications in current cancer therapy.

IgA-Dominant Glomerulopathy and Thrombotic Microangiopathy After Chemotherapy

“…TMA is a well-documented sequela of chemotherapeutic agents, with gemcitabine as one of the most frequently cited. 17 , 18 However, we have noted similar patterns of injury in at least 2 additional patients at our institution with the use of other chemotherapeutic agents, and with newer anti–vascular endothelial growth factor inhibitors, such as bevacizumab in particular (data not shown). The implicated mechanisms of renal injury after vascular endothelial growth factor inhibitors deserves further discussion here, as it implicates a larger group of chemotherapeutics in this pattern of injury, and helps elucidate the pathologic mechanisms at play.…”

Cerebral ischemic events in patients with pancreatic cancer

“…[ 36 , 39 – 41 ] Gemcitabine is more likely to result in systemic infarctions from thrombotic microangiopathy syndromes, associated with other signs like hemolytic anemia, thrombocytopenia, and renal dysfunction. [ 42 – 44 ] Several cases of transitory thrombocytosis have been reported, but with rare thrombotic consequences. [ 45 ] Ischemia induced by 5-fluorouracil is mainly described for the myocardium, but with the same mechanisms as for cisplatin (i.e., hypercoagulable state, vasospasm, and endothelium damage).…”

Thrombotic thrombocytopenic purpura and neurologic manifestations – Case report and integrative review

“…[17] Some anticancer drugs such as Gemcitabin, Mitomycin C, Cisplatin, may also be related to the appearance of TTP. [18] Regarding treatment, PEx should be the first choice because 80% of the patients treated with PEx survive. Immunosuppressants, glucocorticoids and fresh frozen plasma may also be used.…”