Severe gastrointestinal hemorrhage due to concomitant use of bevacizumab and camrelizumab
10.3760/cma.j.cn114015-20240511-00335
- VernacularTitle:贝伐珠单抗联用卡瑞利珠单抗致严重消化道出血
- Author:
Yuesong YIN
1
;
Yanshuo SHI
;
Yupei WU
;
Lien HE
;
Xiaofei XU
;
Xiaoyan FAN
Author Information
1. 河北省人民医院肿瘤科，石家庄 050051
- Publication Type:Journal Article
- Keywords:
Gastrointestinal haemorrhage;
Thrombocytopenia;
Vascular endothelial growth factors;
Immune checkpoint inhibitors;
Bevacizumab;
Camrelizumab
- From:
Adverse Drug Reactions Journal
2024;26(11):702-704
- CountryChina
- Language:Chinese
-
Abstract:
A 67-year-old male patient with intrahepatic bile duct carcinoma was treated with oxaliplatin (hepatic artery perfusion)+gemcitabine (hepatic artery perfusion)+camrelizumab (intravenous infusion)+apatinib (oral). Platelet count (PLT) decline (49×10 9/L) was observed after 2 months (apatinib had been discontinued by himself), which was improved after platelet elevating therapy. Due to multiple tumor metastases, bevacizumab (hepatic arterial perfusion, once per 30 days) was added. Before bevacizumab treatment, PLT and coagulation function of the patient were basically no abnormalities. After 2 cycles of treatments, the PLT was 101×10 9/L and prothrombin time was 14.1 s. Considering the high risk of bleeding in interventional therapy, oxaliplatin and gemcitabine were discontinued, and bevacizumab administration was changed to intravenous infusion. PLT and coagulation function were not improved. Six days after the 5th dose of bevacizumab, the patient had intermittent hematemesis twice (about 300 ml). Laboratory tests showed PLT 75×10 9/L and prothrombin time 15.8 s. The patient was diagnosed with digestive tract hemorrhage. Fasting and water restriction was performed, and gastric acid suppression, hemostasis, parenteral nutrition, etc. were given. The patient had no hematemesis but intermittent black stool. Gastroscopy indicated duodenal ulcer accompanied by bleeding. Rabeprazole and sucralfate were added. Fasting was stopped and liquid diet was given. The next day, the patient had blood in the stool, and the bleeding of the lower digestive tract was judged to be related to camrelizumab and bevacizumab. The bleeding symptoms were slightly improved after treatments with arterial embolization hemostasis and type A cryopprecipitation coagulation factor, etc. Later, the patient had repeated bleeding condition, and finally died despite of rescue efforts.
