Atropine/bevacizumab/epinephrine
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Various toxicities and lack of efficacy: 7 case reports In retrospective study of 70 patients, seven men aged 45-75 year were described, who developed angina pectoris, pulmonary embolism, haemoptysis, proteinuria, myelosuppression, convulsions, cerebral oedema or intestinal perforation during treatment with bevacizumab. Additionally, the man who developed haemoptysis, exhibited lack of efficacy during treatment with epinephrine and atropine [duration of treatments to reactions onsets not stated]. The patients, who were diagnosed with lung cancer (n=4), colon cancer (n=2) or renal malignant tumours (n=1), started receiving IV bevacizumab 100-600mg. Subsequently, the patients developed angina pectoris (n=1), pulmonary embolism (n=1), haemoptysis (n=1), proteinuria (n=1), myelosuppression (n=1), convulsions and cerebral oedema (n=1) or intestinal perforation (n=1) secondary to bevacizumab. Among these, the man who developed haemoptysis was admitted with headache, cough, expectoration and weakness of both lower limbs for 4 months on 10 Jul 2018. On the same day, he had been scheduled to receive a fourth cycle of bevacizumab. He had a significant history of hypertension for 15 years and metastasis lung adenocarcinoma for 3 years. He had received chemotherapy with paclitaxel and carboplatin from 23 May 2015 to 15 September 2015. Thereafter, he received chest radiotherapy and gamma knife therapy with brain radiotherapy for brain metastasis. However, his disease deteriorated. Therefore, bevacizumab 400mg therapy was initiated on 23 April 2018. He subsequently received further doses of bevacizumab on 19 May 2018 and 16 June 2018. At the same time, he received chemotherapy with pemetrexed and cisplatin. Following the chemotherapy, he developed a headache. On 10 Jul 2018, he was admitted for the fourth cycle of chemotherapy. He had been treated with irbesartan and metformin [metformin hydrochloride] with acceptable control on blood pressure and blood glucose level, respectively. On 11 July 2018, at 9.24am, he received bevacizumab 400mg injection for anti-angiogenesis therapy. At 19.54, he developed haemoptysis in large amount, about 500mL. The haemoptysis was bright red gushing from the mouth and nose, containing blood clots. Immediately, bedside ECG was performed and blood pressure and blood oxygen were monitored. Additionally, he started receiving sodium chloride injection for rapid IV rehydration and 1U of Baquting via small pot to stop the haemorrhage. At 19.56, he developed a coma after a brief twitch and did not respond. Subsequent physical examination showed SpO2 of 56%, bilaterally dilated pupils and heart rate and blood pressure were undetectable. Therefore, external chest compression was given and he started receiving IV epinephrine [adrenaline] and atropine to increase the blood pressure and maintain the heart rate. Following the therapy, his blood pressure increased to 73/11mm Hg, the heart rate was 52 beats/min and the electrocardiogram showed ventricular rhythm. Thereafter, bedside tracheal intubation was p
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