Gonzales Paul, Klusewitz Seth, Marowske Johanna, Gancayco John, Osswald Michael B, Setlik Robert
Department of Internal Medicine, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA.
Gastroenterology Service, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA.
Case Rep Oncol Med. 2017;2017:3657812. doi: 10.1155/2017/3657812. Epub 2017 Jun 28.
Breast cancer remains the leading cause of cancer and the third leading cause of cancer related deaths among our population with an estimated number of 246,660 new cases and 40,450 deaths in 2016. With treatment advancements, including targeted agents such as Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, survivability and quality of life continue to improve. However, with the use of these agents come adverse effects, some of which are still being characterized. Our case demonstrates recurrent episodes of gastrointestinal bleeding in a 60-year-old woman being treated with Everolimus for progressive metastatic breast cancer. On endoscopy, bleeding was secondary to erosive gastritis. Previous case reports have described bleeding due to gastric antral vascular ectasia (GAVE), which was described in two prior reported cases. In our case, bleeding also occurred on a reduced dose of Everolimus compared to what is previously reported (5 mg versus 10 mg). As a result of her gastrointestinal bleeding, she required multiple endoscopic interventions including argon plasma coagulation and multipolar heater probe to achieve hemostasis. This is the first case reported of gastrointestinal bleeding not consistent with GAVE and occurring while being on a reduced dose of Everolimus. It is important to document our case so that the Gastroenterology and Hematology communities can be educated and made aware for their patient populations on Everolimus.
乳腺癌仍然是癌症的主要病因，也是我国人群中癌症相关死亡的第三大原因，2016年估计有246,660例新发病例和40,450例死亡。随着治疗方法的进步，包括使用依维莫司（一种哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂）等靶向药物，患者的生存率和生活质量不断提高。然而，使用这些药物会带来一些不良反应，其中一些不良反应仍在研究之中。我们的病例显示，一名60岁患有进行性转移性乳腺癌且正在接受依维莫司治疗的女性出现反复胃肠道出血。内镜检查显示，出血继发于糜烂性胃炎。既往病例报告描述过因胃窦血管扩张症（GAVE）导致的出血，之前有两例相关报道。在我们的病例中，与之前报道的剂量（5毫克对比10毫克）相比，依维莫司减量时也发生了出血。由于她的胃肠道出血，她需要多次内镜干预，包括氩离子凝固术和多极热探头来实现止血。这是首例报道的与GAVE不符且在依维莫司减量时发生的胃肠道出血病例。记录我们的病例很重要，以便胃肠病学和血液学领域的专业人员能够了解情况，并让他们的患者群体对依维莫司有所认识。
