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Delayed pharyngocutaneous fistula caused by molecular targeted therapy: a case report
Mioko Matsuo1, Kazuki Hashimoto2, Rina Jiromaru2
1Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-City, Fukuoka Prefecture, 812-8582, Japan. miolovemio@hotmail.co.jp.
Background:
Molecular-targeted agents used as a treatment for cancer can cause some rare and serious adverse events such as, delayed wound healing. Depending on the anticancer drug used, temporary withdrawal may be recommended before and after surgery to avoid complications. Once a surgical incision has healed and closed completely, wounds rarely open because of the initiation of molecular targeted therapy several months to years after surgery. Here, we aimed to describe a rare complication of pharyngocutaneous fistula in two patients that was thought to be caused by molecular targeted therapy.
Case Presentation:
Case 1 involved a 64-year-old asian man who developed a delayed pharyngocutaneous fistula 3 months after total laryngectomy for laryngeal cancer. Ramucirumab, a vascular endothelial growth factor receptor inhibitor used for recurrent gastric cancer, was speculated to be involved. Case 2 involved a 71-year-old japanese man who developed a delayed pharyngocutaneous fistula 2 years and 1 month after total pharyngeal laryngectomy for pharyngeal cancer. It was speculated that imatinib, a platelet-derived growth factor receptor alpha inhibitor used for chronic myeloid leukemia, was involved.
Conclusions:
Although the incidence of late drug-induced anastomotic leakage is very low, when it occurs, it makes oral intake impossible for an extended period and interferes with the appropriate cancer treatment. In this report, we demonstrate the details of these two patients with such a rare complication, which may help accumulate essential data on this topic.
Insights
Molecular-targeted cancer therapies can rarely cause delayed wound healing, leading to complications like pharyngocutaneous fistulas. This report details two such cases linked to specific targeted agents, highlighting a rare adverse event in cancer treatment.
Area of Science:
- Oncology
- Surgical Oncology
- Pharmacology
Background:
- Molecular-targeted agents for cancer treatment can cause rare adverse events, including delayed wound healing.
- Temporary drug withdrawal is sometimes recommended around surgical procedures to mitigate complications.
- Late-onset complications from these therapies, occurring months or years post-surgery, are uncommon.
Observation:
- Two patients developed delayed pharyngocutaneous fistulas significantly after their surgeries.
- Case 1: A 64-year-old man developed a fistula 3 months post-laryngectomy, potentially linked to ramucirumab.
- Case 2: A 71-year-old man developed a fistula over 2 years post-pharyngolaryngectomy, possibly related to imatinib.
Findings:
- The study describes two rare instances of delayed pharyngocutaneous fistula formation.
- These fistulas are suspected to be induced by molecular-targeted therapy initiated months to years after surgery.
- The specific agents implicated were ramucirumab and imatinib.
Implications:
- Late drug-induced anastomotic leakage, though rare, can severely impair oral intake and disrupt cancer treatment.
- This case report contributes valuable data on a rare complication of molecular-targeted cancer therapies.
- Understanding these rare events is crucial for managing patients undergoing cancer treatment and surgery.
