Advertisement

Severe gastrointestinal hemorrhage related to everolimus: a case report

  • Masashi TsunematsuEmail author
  • Koichiro Haruki
  • Ryota Saito
  • Michiaki Watanabe
  • Masataka Masubuchi
  • Katsuhiko Yanaga
Case Report
  • 69 Downloads

Abstract

Everolimus is an mTOR (the mammalian target of rapamycin) inhibitor, which is used for the treatment of advanced renal cell carcinoma. Life-threatening hemorrhages are extremely rare adverse effect of everolimus. We herein report a successfully treated case of severe everolimus-related gastrointestinal hemorrhage by emergency surgical resection for patient with advanced renal cell carcinoma. A 72-year-old male was diagnosed with renal cell carcinoma, for which everolimus was administered after unsuccessful treatment with sunitinib and sorafenib. The patient suddenly developed hematemesis 4 weeks after administration. Upper gastrointestinal endoscopy showed gastric antral vascular ectasia. Once the hemorrhage was successfully cauterized by argon plasma coagulation, everolimus was discontinued. However, the patient after re-administration of everolimus developed hematemesis again and exhibited hemorrhage shock. Since therapeutic endoscopy could not achieve hemostasis, the patient underwent emergency distal gastrectomy with Billroth I reconstruction. The patient’s vital signs and hemoglobin level stabilized after the surgery. Thereafter, the patient made a satisfactory recovery, and was discharged on postoperative day 10.

Keywords

Everolimus mTOR inhibitors Gastrointestinal hemorrhage 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed consent

The patient has given consent for the publication of images.

References

  1. 1.
    Motzer RJ, Escudier B, Oudard S, et al. Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet. 2008;372:449–56.CrossRefGoogle Scholar
  2. 2.
    Assi H, Abdel-Samad N. Severe gastrointestinal hemorrhage during targeted therapy for advanced breast carcinoma. Curr Oncol. 2014;21:e732–5.CrossRefGoogle Scholar
  3. 3.
    Gonzales P, Klusewitz S, Marowske J, et al. Everolimus implicated in case of severe gastrointestinal hemorrhage. Case Rep Oncol Med. 2017;2017:3657812.Google Scholar
  4. 4.
    Fujihara S, Mori H, Kobara H, et al. Life-threatening gastrointestinal bleeding during targeted therapy for advanced renal cell carcinoma: a case report. BMC Nephrol. 2013;14:141.CrossRefGoogle Scholar
  5. 5.
    Fujihara S, Mori H, Kobara H, et al. Uncommon gastrointestinal bleeding during targeted therapy for advanced renal cell carcinoma: a report of four cases. Oncol Lett. 2015;10:2895–8.CrossRefGoogle Scholar
  6. 6.
    Kim YW, Lee WH, Choi SM, et al. DA6034 promotes gastric epithelial cell migration and wound-healing through the mTOR pathway. J Gastroenterol Hepatol. 2012;27:397–405.CrossRefGoogle Scholar
  7. 7.
    Jin T, Fei BY, Zheng WH, et al. Successful treatment of refractory gastric antral vascular ectasia by distal gastrectomy: a case report. World J Gastroenterol. 2014;20:14073–5.CrossRefGoogle Scholar
  8. 8.
    Naidu H, Huang Q, Mashimo H. Gastric antral vascular ectasia: the evolution of therapeutic modalities. Endosc Int Open. 2014;2:E67–73.CrossRefGoogle Scholar
  9. 9.
    Parrado RH, Lemus HN, Coral-Alvarado PX, et al. Gastric antral vascular ectasia in systemic sclerosis: current concepts. Int J Rheumatol. 2015;2015:762546.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of SurgeryAtsugi City HospitalAtsugiJapan
  2. 2.Department of SurgeryThe Jikei University School of MedicineTokyoJapan
  3. 3.Department of SurgeryThe Jikei University School of MedicineTokyoJapan

Personalised recommendations