Regorafenib-induced retinal and gastrointestinal hemorrhage in a metastatic colorectal cancer patient with liver dysfunction

Tsuchihashi, Kazufumi; Shimokawa, H; Takayoshi, Kotoe; Nio, Kenta; Aikawa, Tomomi; Matsushita, Yuzo; Wada, Iori; Arita, Shuji; Ariyama, Hiroshi; Kusaba, Hitoshi; Sonoda, Koh Hei; Akashi, Koichi; Baba, Eishi

doi:10.1097/md.0000000000008285

Cited by 6 publications

(3 citation statements)

References 17 publications

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“… 4 One case study reported retinal hemorrhage and mild hematochezia in a patient with underlying liver dysfunction. 5 However, profuse gastrointestinal/rectal bleeding complication from regorafenib-induced radiation recall with endoscopic evidence of proctitis in a patient pretreated with radiotherapy has not been reported in the literature before, to the best of our knowledge.…”

Section: Discussionmentioning

confidence: 82%

Regorafenib-Induced Radiation Recall Presenting as Acute Blood Loss Anemia With Rectal Bleeding and Severe Proctitis

Urella

Shenouda

Pacioles

2023

Journal of Investigative Medicine High Impact Case Reports

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Radiation recall is a rare inflammatory reaction that occurs in an area that was subjected to prior irradiation that is usually triggered by certain drugs or chemotherapy agents. This reaction is drug-specific for each individual and occurs in about 6% to 9% of the patients receiving chemotherapy after radiation therapy. We report a case of radiation recall–induced severe proctitis which is thought to be triggered by administration of regorafenib for stage IV rectal adenocarcinoma with lung metastases. We present a 65-year-old female patient who was initially diagnosed with stage III T4N1M0 rectal adenocarcinoma that was treated with neoadjuvant concurrent chemoradiotherapy, followed by low anterior resection. The tumor was pathologically staged a ypT3 yN1 with a partial response to the treatment. After the surgery, the patient was found to have lung nodules consistent with metastatic disease, when she was treated initially with folinic acid, fluorouracil, and oxaliplatin, plus bevacizumab. The patient had further disease progression with metastases in her lungs despite treatment with several chemotherapy agents. She was started on regorafenib, an oral vascular endothelial growth factor inhibitor, as a fourth line of therapy. However, in a month after initiation of oral regorafenib, and 9 months after the prior radiation treatment, the patient presented to the emergency room with a complaint of bright red blood per rectum. She was diagnosed with severe radiation proctitis that was treated therapeutically with argon plasma coagulation. This particular case serves as a reminder that although infrequent and rare, radiation recall may result in an inflammatory reaction in an organ such as rectum. To the best of our knowledge, this regorafenib-induced severe proctitis secondary to radiation recall has not been reported in the literature before.

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Section: Discussionmentioning

confidence: 82%

Regorafenib-Induced Radiation Recall Presenting as Acute Blood Loss Anemia With Rectal Bleeding and Severe Proctitis

Urella

Shenouda

Pacioles

2023

Journal of Investigative Medicine High Impact Case Reports

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“…Most tumors represented by liver cancer have an abundant blood supply (31). In the process of tumor invasion and metastasis, vascular invasion or tumor compression of the peripheral blood vessels may lead to tumor-associated hemorrhage (32), such as hemoptysis caused by lung cancer (33), gastrointestinal hemorrhage caused by gastrointestinal cancer (34,35), hematuria caused by bladder cancer and renal cancer, and vaginal bleeding caused by cervical cancer (36,37).…”

Section: Hemorrhage Caused By Tumor Invading Blood Vesselsmentioning

confidence: 99%

Clinical application of interventional embolization in tumor-associated hemorrhage

Chen¹,

Yang

Xu³

et al. 2020

Ann Transl Med

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Recently, the main clinical treatment methods for tumor-associated hemorrhage include systemic therapy, the application of hemostatic drugs, blood transfusion, symptomatic support therapy and endoscopic interventional hemostasis. Endoscopic hemostasis is performed mainly for patients with gastrointestinal bleeding, and the procedures include hardening of the blood vessels and the injection of hemostatic drugs.Surgical hemostasis methods mainly include the surgical ligation of bleeding blood vessels or tumor resection for hemostasis. Interventional hemostasis is a new hemostasis method. With the development of interventional radiology in recent years, transcatheter arterial embolization (TAE) can quickly detect and accurately embolize arterial blood vessels. It is the preferred treatment for present tumor-associated hemorrhages.

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“…In the article, “Regorafenib-induced retinal and gastrointestinal hemorrhage in a metastatic colorectal cancer patient with liver dysfunction: A case report” [ 1 ] , which appeared in Volume 96, Issue 42 of Medicine , Dr. Koh-Hei Sonoda's affiliation should have been affiliation f, Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka.…”

mentioning

confidence: 99%