There are no effective conventional systemic cytotoxic therapies for patients with unresectable or advanced hepatocellar carcinoma (HCC). Sorafenib, an oral multi-targeted tyrosine kinase inhibitor, was recently approved for the treatment of patients with HCC. Sorafenib is generally well tolerated and has an acceptable toxicity profile. Gastrointestinal perforation is a rare adverse event. We present a case of transverse colon perforation during sorafenib therapy for advanced HCC. A 68-year-old woman with advanced HCC was treated with sorafenib. Eight weeks later the patient presented with the sudden onset of sharp abdominal pain. Emergency surgery was performed for panperitonitis and a perforation involving the transverse colon.
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5.
HapaniS., ChuD., WuS.: Risk of gastrointestinal perforation in patients with cancer treated with bevacizumab: a meta-analysis.Lancet Oncol, 10: 559–568, 2009.
6.
BadgwellB.D., CampE.R., FeigB., WolffR.A., EngC., EllisL.M., CormierJ.N.: Management of bevacizumab-associated bowel perforation: a case series and review of the literature.Ann Oncol, 19: 577–582, 2008.
7.
HeinzerlingJ.H., HuertaS.: Bowel perforation from bevacizumab for the treatment of metastatic colon cancer: incidence, etiology, and management.Curr Surg, 63: 334–337, 2006.
8.
TolJ., CatsA., MolL., KoopmanM., BosM.M., van der HoevenJ.J., AntoniniN.F., van KriekenJ.H., PuntC.J.: Gastrointestinal ulceration as a possible side effect of bevacizumab which may herald perforation.Investig New Drugs, 26: 393–397, 2008.
9.
HanE.S., MonkB.J.: What is the risk of bowel perforation associated with bevacizumab therapy in ovarian cancer?Gynecol Oncol, 105: 3–6, 2007.
10.
KambaT., TamB.Y., HashizumeH., HaskellA., SenninoB., MancusoM.R., NorbergS.M., O'BrienS.M., DavisR.B., GowenL.C., AndersonK.D., ThurstonG., JohoS., SpringerM.L., KuoC.J., McDonaldD.M.: VEGF-dependent plasticity of fenestrated capillaries in the normal adult microvasculature.Am J Physiol Heart Circ Physiol, 290: 560–576, 2006.
11.
KambaT., McDonaldD.M.: Mechanisms of adverse effects of anti-VEGF therapy for cancer.Br J Cancer, 96: 1788–1795, 2007.
12.
WangY., FeiD., VanderlaanM., SongA.: Biological activity of bevacizumab, a humanized anti-VEGF antibody in vitro.Angiogenesis, 7: 335–345, 2004.
13.
ScappaticciF.A., SkillingsJ.R., HoldenS.N., GerberH.P., MillerK., KabbinavarF., BergslandE., NqaiJ., HolmgrenE., WangJ., HurwitzH.: Arterial thromboembolic events in patients with metastatic carcinoma treated with chemotherapy and bevacizumab.J Natl Cancer Inst, 99: 1232–1239, 2007.
14.
NalluriS.R., ChuD., KeresztesR., ZhuX., WuS.: Risk of venous thromboembolism with the angiogenesis inhibitor bevacizumab in cancer patients: a meta-analysis.JAMA, 300: 2277–2285, 2008.
15.
ChoueiriT.K., SchutzF.A., JeY., RosenbergJ.E., BellmuntJ.: Risk of arterial thromboembolic events with sunitinib and sorafenib: a systematic review and meta-analysis of clinical trials.J Clin Oncol, 28: 2280–2285, 2010.
16.
Ben-HorinS., BardanE., BarshackI., ZaksN., LivnehA.: Cholesterol crystal embolization to the digestive system: characterization of a common, yet overlooked presentation of atheroembolism.Am J Gastroenterol, 98: 1471–1479, 2003.
17.
MirO., MouthonL., AlexandreJ., MallionJ.M., DerayG., GuillevinL., GoldwasserF.: Bevacizumab-induced cardiovascular events: a consequence of cholesterol emboli syndrome?J Natl Cancer Inst, 99: 85–86, 2007.
18.
SchellhaasE., LoddenkemperC., SchmittelA., BuhrH.J., PohlenU.: Bowel perforation in non-small cell lung cancer after bevacizumab therapy.Invest New Drug, 27: 184–187, 2008.
19.
LordickF., GeinitzH., TheisenJ., SendlerA., SarbiaM.: Increased risk of ischemic bowel complications during treatment with bevacizumab after pelvic irradiation: report of three cases.Int J Radiat Oncol Biol Phys, 64: 1295–1298, 2006.
20.
O'LearyD.P., MyersE., MoranS., BrowneT.J., HarneyS., KirwanW.O.: Adalimumab therapy-a double-edged sword?Int J Colorectal Dis, Jan 11, 2011 [Epub ahead of print].
