Life-threatening gastrointestinal bleeding during targeted therapy for advanced renal cell carcinoma: a case report

BMC Nephrology

Tsutomu Masaki¹  Yoshiyuki Kakehi²  Mikio Sugimoto²  Yuji Hayashida²  Takehiro Suenaga²  Hideki Kobara¹  Hirohito Mori¹  Shintaro Fujihara¹ 

[1] Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine/Graduate School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan;Department of Urology, Kagawa University, Faculty of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan

关键词: Argon plasma coagulation;    Targeted therapy;    Gastric antral vascular ectasia;    Temsirolimus;    Gastrointestinal bleeding;   

Others  :  1082898
DOI  :  10.1186/1471-2369-14-141

 received in 2012-12-03, accepted in 2013-07-08,  发布年份 2013

【 摘 要 】

Background

Temsirolimus has important clinical activity in both untreated and previously treated patients with advanced renal cell carcinoma. Targeted therapy–related stomatitis and mucositis have occurred during targeted therapies, but there is no consensus on which strategy is the most effective. We herein report a case in which several sessions of endoscopic hemostasis with argon plasma coagulation (APC) effectively resolved life-threatening gastrointestinal bleeding that had occurred during targeted therapy. This is the first case report of such an adverse drug reaction in the literature.

Case presentation

A 47-year-old female patient with advanced renal cell carcinoma was treated with temsirolimus. Eight weeks after starting targeted therapy, the patient was admitted to our hospital for worsened fatigue, pallor, and hematemesis. A complete blood count showed a marked drop in her hemoglobin level from 10.1 g/dl 4 days earlier to 2.9 g/dl. Esophagogastroduodenoscopy revealed diffuse mucosal bleeding of the antrum. Endoscopy revealed diffuse reddish spots that resembled gastric antral vascular ectasia (GAVE) extending from the pylorus into the antrum. One month after endoscopic hemostasis with APC and stopping temsirolimus, significant improvement was shown in the gastric erythema and GAVE like lesions.

Conclusion

Minor hemorrhagic events are relatively common in patients treated with targeted agents. Life-threatening hemorrhagic events are rarer than minor hemorrhagic complications. In the present case, endoscopic hemostasis with APC effectively prevented severe anemia and blood loss due to gastrointestinal bleeding.

【 授权许可】

   
2013 Fujihara et al.; licensee BioMed Central Ltd.

【 图 表 】

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