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Hemorrhagic pseudoaneurysm in a patient receiving aflibercept for metastatic thyroid cancer
Shrujal S Baxi1, Eric J Sherman, Katherine W Kelly
1Head and Neck Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. baxis@mskcc.org
Background:
Agents such as 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. The hemorrhage of aberrant vasculature should be included in the differential diagnosis in patients presenting with vague complaints while being treated with anti-angiogenic agents.
Insights
Aflibercept, an anti-angiogenic drug for metastatic thyroid cancer, can cause rare but serious hemorrhagic complications. This case highlights the risk of pseudoaneurysm formation in patients treated with VEGF inhibitors.
Area of Science:
- Oncology
- Vascular Biology
Background:
- Anti-angiogenic agents targeting the VEGF pathway, such as aflibercept, are investigated for metastatic differentiated thyroid cancer.
- These therapies aim to inhibit tumor angiogenesis but may affect normal vasculature.
Observation:
- A 67-year-old woman developed abdominal pain, nausea, and vomiting after initiating aflibercept for metastatic thyroid cancer.
- She experienced internal hemorrhaging and a drop in hematocrit, with no prior history of vascular issues.
Findings:
- An angiogram revealed an occluded celiac artery and a bleeding pseudoaneurysm in the inferior pancreaticoduodenal artery.
- The patient stabilized after the pseudoaneurysm was successfully treated with coiling.
Implications:
- Anti-angiogenic therapies can disrupt endothelial stability, leading to hemorrhagic or thrombotic events.
- Hemorrhage from aberrant vasculature should be considered in patients on anti-angiogenic agents presenting with unexplained symptoms.
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