Published online Jul 24, 2020. doi: 10.5306/wjco.v11.i7.504
Peer-review started: February 14, 2020
First decision: May 28, 2020
Revised: June 2, 2020
Accepted: June 10, 2020
Article in press: June 10, 2020
Published online: July 24, 2020
Processing time: 156 Days and 20.1 Hours
Bevacizumab is an antiangiogenic agent, and that synergizes with chemotherapeutic drugs. When used in combination therapies, Bevacizumab is associated with adverse events such as hemorrhage, gastrointestinal perforation, delayed wound healing, and pneumothorax. However, the molecular mechanisms underlying these adverse events are not fully understood.
A 45-year-old female with multiple lung metastases that were derived from primary breast cancer, was placed on Bevacizumab + paclitaxel therapy, since this combination has a potent antitumor effect. She reported dyspnea before cycle 3, day 1 and we therefore ran a chest X-ray, which detected a right pneumothorax. The coronal plane computed tomography revealed that one solid mass rapidly necrosed and was replaced by a cavity that passed through the bronchus in the right lower lobe. The cavity eventually ruptured the pleura and made the bronchopleural fistula that led to this pneumothorax. Thoracic cavity drainage using an intercostal catheter was performed. On the 7th day of drainage, the patient was discharged from our hospital on recovery. Recurrence of pneumothorax was not reported, and continuation of chemotherapy was made possible by changing the regimen.
Patients with lung metastases surrounding the bronchi and on the pleura should be monitored for pneumothorax by Bevacizumab-containing chemotherapies.
Core tip: Combination therapy with Bevacizumab and chemotherapy is used to expect its high antitumor effect. However, Bevacizumab-containing combination therapies can induce severe adverse events. Mechanisms and risk factors that underlie the onset of pneumothorax are not clear. Here, we report a case of pneumothorax associated with a combination therapy of Bevacizumab with chemotherapy, and discuss the mechanisms and risk factors. Patients with multiple lung metastases surrounding the bronchi and on the pleura, should be monitored for pneumothorax, an adverse event that can be induced by the rapid necrosis due to Bevacizumab-containing combination chemotherapies.