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Severe gastrointestinal hemorrhage during targeted therapy for advanced breast carcinoma
1Division of Medical Oncology/Hematology, The Moncton Hospital, Moncton, NB. ; Department of Medicine, Dalhousie University, Halifax, NS.
Abstract:
The introduction of targeted agents has improved survival for patients with a number of types of cancer, including several breast cancer subtypes. However, these agents are not without toxicities, and the fact that many patients are now on targeted therapy for extended periods of time has presented new challenges for the management of adverse effects. Everolimus is an inhibitor of mtor (the mammalian target of rapamycin) that is used as targeted therapy for advanced, hormone receptor-positive, her2-negative breast cancer in postmenopausal women in combination with exemestane, after treatment failure with letrozole or anastrozole. Minor hemorrhagic events are relatively common with targeted agents, but life-threatening hemorrhages, although uncommon, can also occur. We report a case of life-threatening gastrointestinal bleeding in a 48-year-old woman being treated with everolimus for advanced infiltrating ductal carcinoma of the breast. The bleeding was successfully treated with 13 sessions of endoscopic hemostasis using argon plasma coagulation.
Insights
Everolimus, a targeted therapy for advanced breast cancer, can cause rare but life-threatening gastrointestinal bleeding. This case highlights the importance of managing adverse effects, even uncommon ones, during extended targeted cancer treatment.
Area of Science:
- Oncology
- Pharmacology
Background:
- Targeted therapies have improved cancer survival, but managing their toxicities during long-term use is challenging.
- Everolimus (an mTOR inhibitor) is used for advanced hormone receptor-positive, HER2-negative breast cancer.
- Hemorrhagic events are known toxicities of targeted agents.
Purpose of the Study:
- To report a case of life-threatening gastrointestinal bleeding in a patient treated with everolimus.
- To describe the successful management of this rare adverse event.
Main Methods:
- A case report of a 48-year-old woman with advanced infiltrating ductal carcinoma of the breast.
- Treatment with everolimus in combination with exemestane.
- Management of gastrointestinal bleeding using endoscopic hemostasis with argon plasma coagulation.
Main Results:
- The patient experienced life-threatening gastrointestinal bleeding.
- Bleeding was successfully controlled after 13 sessions of argon plasma coagulation.
Conclusions:
- Life-threatening gastrointestinal bleeding is a rare but serious adverse event associated with everolimus therapy.
- Endoscopic hemostasis using argon plasma coagulation can be an effective treatment for everolimus-induced gastrointestinal bleeding.
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