Occult gastrointestinal perforation in a patient with EGFR mutant non-small-cell lung cancer receiving combination chemotherapy with atezolizumab and bevacizumab: a brief report

2019 
Abstract Introduction/Background Combination therapy with atezolizumab, bevacizumab, carboplatin and paclitaxel (ABCP) is a recently approved treatment for patients with metastatic non-squamous non-small-cell lung cancer (NSCLC). It is essential for prescribers to be aware of its potential toxicity profile, including rare but possible fatal events. Herein we describe a case of fatal intestinal perforation, likely the product of sequential stereotactic ablative body radiotherapy (SABR) and ABCP. Case Report A 66-year-old man was diagnosed with metastatic NSCLC harbouring an exon 19 epithelial growth factor receptor (EGFR) mutation in September 2013. He experienced oligometastatic disease progression on targeted therapies and in October 2017, he received SABR to a coeliac axis lymph node. Further disease progression with in the lungs lead to him commencing ABCP therapy in July 2018, with rapid resolution of his disease-related symptoms. However, after two cycles of therapy, he developed upper abdominal post-prandial pain with resultant anorexia. This was ultimately diagnosed as resulting from an area of localised perforation at the gastro-esophageal junction, which subsequently culminated in a fatal bleeding event. Conclusion Given the increasing uptake of both SABR and bevacizumab-based therapy for NSCLC, clinicians should be cautious of the potentially increased risk of gastrointestinal toxicity when combining these modalities.
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