Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6507
Peer-review started: August 8, 2021
First decision: November 6, 2021
Revised: November 15, 2021
Accepted: May 5, 2022
Article in press: May 5, 2022
Published online: July 6, 2022
Processing time: 320 Days and 3.9 Hours
In driver gene-negative non-small cell lung cancer patients who relapse following radical resection, combination chemotherapy using bevacizumab and platinum-based dual drugs is known to increase both progression-free and overall survival. Treatment initially includes bevacizumab, and if patients are able to tolerate it, bevacizumab can continue to be utilized until disease progression. Bevacizumab is a recombinant humanized monoclonal neutralizing antibody that acts against vascular endothelial growth factor (VEGF). Various anti-VEGF monoclonal antibodies, such as bevacizumab, can increase the risk of arterial thromboembolism. Current data indicate that VEGF-targeted treatment does not significantly increase the risk of venous thromboembolism events, except for bevacizumab.
A 55-year-old man underwent radical resection for cancer of the right lung. Six months following surgery, multiple metastases were observed in his left lung. Subsequently, six cycles of bevacizumab combined with pemetrexed/carboplatin chemotherapy was given. Efficacy evaluation continued to be partial relief according to RECIST 1.1 standards, and no noticeable adverse reactions were noted. After three cycles of maintenance therapy using a combination of bevacizumab and pemetrexed, the patient developed dizziness and dyspnea. The patient was diagnosed with acute cerebral infarction and pulmonary embolism following head magnetic resonance imaging, computed tomography (CT) angiography, and chest enhanced CT. Although the patient received low-molecular-weight heparin anticoagulation and other treatment, the patient eventually died of respiratory failure 1 mo later. This case report may offer some insight into fatal arteriovenous embolism, which has not been previously reported.
Bevacizumab combined with chemotherapy may also increase the risk of arteriovenous thromboembolism. Accordingly, patients who receive angiogenesis inhibitor therapy should be carefully selected. Furthermore, close monitoring and timely intervention are necessary in order to reduce the risk of such toxicities.
Core Tip: This report describes a middle-aged man with postoperative recurrence of non-small cell lung cancer who developed cerebral infarction and pulmonary embolism 6 mo after treatment with bevacizumab, which was given in combination with chemotherapy. Concurrent arteriovenous thrombosis is rarely reported in the literature. Bevacizumab in conjunction with chemotherapy may increase the risk of arteriovenous thromboembolism. As a result, patients who undergo treatment with angiogenesis inhibitors should be carefully selected, and close monitoring and timely interventions (such as low-molecular-weight heparin prophylactic anticoagulant therapy) are necessary in order to reduce the risk of arterial thromboembolism and venous thromboembolism.