Department of Minimally Invasive Surgery Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX.
Clin Colorectal Cancer. 2020 Sep;19(3):e117-e123. doi: 10.1016/j.clcc.2020.03.002. Epub 2020 Mar 19.
Data on gastrointestinal toxicities related antiangiogenesis cancer therapy is very limited. We aim to describe the clinical, endoscopic, and histologic features and outcomes of antiangiogenesis-associated colitis and diarrhea (ACD) at a tertiary-care cancer center.
We performed a retrospective study of cancer patients who received antiangiogenesis therapy (AAT) and underwent endoscopy for ACD symptoms during 2000-2018.
A total of 12,045 patients received AAT during the study period. Of these, 552 patients underwent lower gastrointestinal tract endoscopic evaluation after AAT. Among them, we identified 41 patients who developed ACD. The median time from AAT initiation to ACD onset was 20 weeks. Most patients received bevacizumab (83%). The median duration of ACD symptoms was 6 days. On endoscopy, 7 patients (17%) had mucosal ulceration, and 16 (39%) had nonulcerative inflammation. Active histologic inflammation was evident in 8 patients (20%). Thirteen patients (32%) received treatment for ACD: antibiotics in 5 (12%) and antimotility agents in 11 (27%). Sixteen patients (39%) were hospitalized for ACD, and 2 were admitted to the intensive care unit. One colonic perforation (2%) related to underlying malignancy was reported after colonoscopy. Patients with enterocolitis symptoms had more frequent abnormal endoscopic findings (P = .024) and less frequently received antimotility agents (P = .011) compared to those with diarrhea only. Abnormal endoscopic findings were associated with more hospitalizations (P = .063) compared to normal group.
ACD is a rare adverse event of AAT and is usually mild. Despite its rarity, complications of ACD can be serious, requiring intensive care unit and surgery. Colonic perforation occurred after routine endoscopy after AAT in 2% of our cohort.
与抗血管生成癌症治疗相关的胃肠道毒性的数据非常有限。我们旨在描述一家三级癌症中心接受抗血管生成治疗（AAT）的癌症患者的临床、内镜和组织学特征以及抗血管生成相关性结肠炎和腹泻（ACD）的结局。
我们对 2000 年至 2018 年间接受 AAT 并因 ACD 症状而行内镜检查的癌症患者进行了回顾性研究。
在研究期间，共有 12045 名患者接受了 AAT。其中，552 名患者在接受 AAT 后接受了下消化道内镜评估。在这些患者中，我们发现 41 名患者发生了 ACD。从 AAT 开始到 ACD 发作的中位时间为 20 周。大多数患者接受贝伐单抗治疗（83%）。ACD 症状的中位持续时间为 6 天。内镜下，7 例（17%）有黏膜溃疡，16 例（39%）有非溃疡性炎症。8 例（20%）有明显的组织学炎症。13 例（32%）接受了 ACD 的治疗：5 例（12%）用抗生素，11 例（27%）用止吐药。16 例（39%）因 ACD 住院，2 例住进重症监护病房。在结肠镜检查后报告了 1 例（2%）与潜在恶性肿瘤相关的结肠穿孔。与仅有腹泻的患者相比，有肠炎症状的患者更常出现异常内镜表现（P =.024），且较少使用止吐药（P =.011）。与正常组相比，异常内镜表现与更多的住院治疗相关（P =.063）。
ACD 是 AAT 的一种罕见不良反应，通常为轻度。尽管罕见，但 ACD 的并发症可能很严重，需要入住重症监护病房和手术治疗。在我们的队列中，2%的患者在 AAT 后常规内镜检查后发生了结肠穿孔。
