Bevacizumab
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Worsening of hypertension, and acute aortic dissection (first report) in an elderly patient: case report A 70-year-old man experienced a worsening of his hypertension followed by acute aortic dissection, while receiving bevacizumab as part of a clinical trial investigating metastatic prostate cancer. The man, who had pre-existing but well-controlled hypertension of 25 years’ duration, had already been treated for his castrate-resistant prostate cancer with a radical prostatectomy and hormonal deprivation therapy. He was started on bevacizumab 15 mg/kg cyclically every 21 days, along with docetaxel, thalidomide and prednisone. Ten months later, he developed grade 3 hypertension (National Cancer Institute Common Toxicity Criteria)* . The man’s usual calcium channel antagonist dose was increased and hydralazine was initiated, resulting in an improvement in BP control. A chest CT scan subsequently revealed acute descending aortic dissection up to the level of the renal arteries. He was started on a labetalol nitrite drip. Acute tubular necrosis and contrast-induced nephropathy also occurred, but resolved after conservative measures. He was removed from the clinical trial and optimally maintained on four anti-hypertensive medications. At last follow-up, his BP was 126/70mm Hg. It was planned that he would continue on docetaxel and prednisone alone, without bevacizumab or thalidomide. Author comment: "Our patient already had pre-existing hypertension which gradually worsened with continued administration of bevacizumab. . . [E]xtreme caution should be undertaken, and rigorous monitoring employed, to prevent possible complications that could ensue as a result of poorly controlled hypertension." * Elsewhere in the paper it states that he experienced hypertensive symptoms after 28 treatment cycles. Aragon-Ching JB, et al. Acute aortic dissection in a hypertensive patient with prostate cancer undergoing chemotherapy containing bevacizumab. Acta 801118803 Oncologica 47: 1600-1601, No. 8, 2008 - USA
» Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of aortic dissection associated with bevacizumab. The WHO Adverse Drug Reactions database contained 11 reports of aortic dissection (using MedDRA terminology), and 15 reports of aneurysm associated with bevacizumab.
0114-9954/10/1230-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 29 Nov 2008 No. 1230
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