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Multiple colon ulcerations, perforation and death during treatment of malignant melanoma with sorafenib
T Frieling1, J Heise, S W Wassilew
1Deptartment of Gastroenterology, Hepatology, Infectiology, Neurogastroenterology, Hematology and Oncology, HELIOS-Clinic Krefeld, Krefeld, Germany. thomas.frieling@helios-kliniken.de
Background:
Sorafenib (Nexavar) is an oral multi-kinase inhibitor with anti-angiogenic and antiproliferative effects. It has shown in-vitro and clinical activity against several kinds of tumors, such as malignant melanoma.
History, Diagnosis, Treatment And Course:
A 66-year-old man with malignant melanoma was treated with sorafenib, 2 yen 400 mg per day. Because of severe diarrhea and abdominal pain, sorafenib was eventually discontinued and the patient was hospitalized for further treatment. Diagnostic work-up by upper gastrointestinal endoscopy and colonoscopy revealed multiple deep ulcerations within the whole colon. One week after admission the patient developed symptoms of acute abdomen with signs of bowel perforation requiring an emergency operation. Colectomy of the right colon with ileostomy revealed multiple (20-30) acute and subacute colonic perforations. Despite intensive care treatment the patient died of septic complications 13 days after surgery.
Conclusion:
Treatment with anti-angiogenic multi-kinase inhibitors may be associated with gastrointestinal perforations. This has been reported for sorafenib in up to 2.3 % of cases.
Insights
Sorafenib, an anti-angiogenic drug, can cause severe gastrointestinal perforations, as seen in a malignant melanoma patient. This rare but serious side effect requires careful monitoring during treatment.
Area of Science:
- Oncology
- Pharmacology
Background:
- Sorafenib is an oral multi-kinase inhibitor with anti-angiogenic and antiproliferative properties.
- It has demonstrated efficacy against various cancers, including malignant melanoma.
Observation:
- A 66-year-old male with malignant melanoma experienced severe gastrointestinal complications, including diarrhea and abdominal pain, during sorafenib treatment.
- Endoscopic evaluation revealed multiple deep colonic ulcerations, leading to bowel perforation and requiring emergency surgery.
- The patient ultimately died from septic complications post-colectomy.
Findings:
- Treatment with sorafenib was associated with multiple acute and subacute colonic perforations.
- Gastrointestinal perforations represent a potential complication of anti-angiogenic multi-kinase inhibitor therapy.
Implications:
- Clinicians should be aware of the risk of gastrointestinal perforations in patients treated with sorafenib.
- This case highlights the importance of vigilant monitoring for severe gastrointestinal adverse events during treatment with this class of drugs.
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