Retinal vein thrombosis in a patient with metastatic colon cancer receiving XELOX chemotherapy combined with bevacizumab pre-hepatic resection

Abstract

Retinal vein thrombosis is a common vascular occlusive disorder of the retina responsible for varying degrees of vision impairment. It is an adverse effect rarely associated with cancer and its treatment. We report the case of a patient with metastatic colon cancer who developed central retinal vein thrombosis (CRVT) in the right eye following two cycles of chemotherapy with capecitabine and oxaliplatin (XELOX) plus bevacizumab given prior to hepatic resection. Despite cessation of chemotherapy, vision has not improved. The etiology of the CRVT in this case is not clear due to risk factors for venous thrombotic events including colonic malignancy and previous major surgery. However, the proximity of chemotherapy administration to the initial development of symptoms suggests the possibility of a medication-related cause, with bevacizumab and capecitabine the most likely suspects.

Central retinal vein occlusion in patients with metastatic solid tumors on tyrosine kinase inhibitors: a report of case series and literature review

“…Bevacizumab, a commonly used anti-VEGF agent in systemic chemotherapy, is also the first generation of anti-VEGF agents for intravitreal injections. It increases the risk of venous thromboembolism development in cancer patients ( 32 ), and RVO is reported as an adverse effect when combined with chemotherapy for metastatic colorectal cancer ( 33 ). Although the underlying mechanism has not been fully elucidated, these observations justify the causal relationship between anti-VEGF agents and RVO.…”

Risk of retinal vein occlusion in colorectal cancer patients receiving anti-vascular endothelial growth factors – a population-based cohort study

“…This study is the first large cohort study to investigate associations between systemic anti-VEGFs, including bevacizumab and regorafenib, and ocular adverse events such as RVO. Previously there were only case reports, which could hardly disclose any associations [ 4 ]. The nationwide and population-based design of this study has good statistical power and risk appraisal precision, especially since we used the TCR, which contains definite diagnoses of colorectal cancers.…”

“…We retrieved all medical records from the one-year period prior to the date of cancer diagnosis to determine the baseline characteristics of the patients. The covariates were selected according to information from previous studies and experts’ opinions, included patients’ age at index date, sex and comorbidities related to RVO [ 3 , 4 , 6 , 7 ]. The comorbidities, including diabetes mellitus (DM), hypertension, dyslipidemia, renal diseases, heart disease, COPD, pneumonia, cataract and glaucoma, were identified using ICD-9-CM or ICD-10-CM codes.…”

“…Bevacizumab has been used in the treatment of different cancers for a long time. Retinal vein occlusion (RVO) has been reported as an adverse drug effect of bevacizumab combined with chemotherapy for mCRC [ 4 ]. Since there have been very few case reports discussing this association, we aimed to use a large population−based cohort design to determine if anti−VEGF treatment in CRC patients is associated with higher risk of RVO.…”