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Hemorrhagic pseudoaneurysm in a patient receiving aflibercept for metastatic thyroid cancer.
MedLine Citation:
PMID:  22356484     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Agents like aflibercept, which target the angiogenic pathway, are of great interest as candidates for the management of metastatic differentiated thyroid cancer. Here we report a patient who developed a hemorrhagic abdominal pseudoaneurysm shortly after being started on this drug. Patient findings: The patient was a 67-year-old woman being treated with single agent aflibercept (VEGF-Trap) for metastatic thyroid cancer. She had no history of intra-abdominal pathology or vascular disease but had been previously treated with sorafenib. Twelve days after receiving her second dose of aflibercept she developed vague abdominal pain which increased in severity and was accompanied by nausea and vomiting. Her symptoms progressed along with a decline in her hematocrit and signs of internal hemorrhaging. An angiogram identified an occluded celiac artery with increased collaterals and a bleeding pseudoaneurysm in the inferior pancreaticoduodenal artery. After the pseudoaneurysm was coiled, the patient stabilized. Summary and Conclusions: Anti-angiogenic agents, usually well-tolerated, can disrupt the delicate balance of normal endothelium leading to hemorrhagic and thrombotic complications. Hemorrhage of aberrant vasculature should be included in the differential diagnosis in patients presenting with vague complaints while being treated with anti-angiogenic agents.
Authors:
Shrujal S Baxi; Eric J Sherman; Katherine W Kelly; Karen T Brown; Ronald P Dematteo; David G Pfister
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-22
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  -     ISSN:  1557-9077     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Memorial Sloan-Kettering Cancer Center, Medicine, 1275 York Ave, Schwartz 1206, New York, New York, United States, 10065, 212-639-4015, 212-717-3278; baxis@mskcc.org.
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