Bellia Maria Alessandra, Sofia Carmelo, Marino Maria Adele, Mazzeo Carmelo, Biondo Santino Antonio, Cucinotta Eugenio, Fleres Francesco
Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98125, Messina, Italy.
Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Section of General Surgery, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
Radiol Case Rep. 2024 Feb 29;19(5):2013-2019. doi: 10.1016/j.radcr.2024.02.018. eCollection 2024 May.
Regorafenib is a multikinase inhibitor approved for treatment of patients with metastatic Colo-Rectal Cancer (mCRC) and Gastro-Intestinal Stromal Tumor (GIST) progression after the administration of other tyrosine-kinase inhibitors such as imatinib and sunitinib. Only a handful of severe side effects such as intestinal perforations and fistulas have been described in the literature in patients undergoing multikinase inhibitor treatment. We report a case of a patient with peritoneal mCRC who experienced an intestinal perforation during the administration of Regorafenib and review the literature. A 48-year-old man with previously resected sigmoid colon cancer and peritoneal metastatic disease under Regorafenib treatment presented to our Emergency Department with severe abdominal pain and asthenia. Abdominal X-ray and contrast-enhanced computed tomography examination revealed an intestinal perforation. The patient underwent emergency surgery which demonstrated acute diffuse peritonitis, necrosis, and perforation of a distal ileal loop affected by peritoneal metastatic disease. The necrosis of peritoneal implants on bowel walls could be regarded as a potential factor leading to intestinal perforation in metastatic colorectal cancer patients undergoing Regorafenib treatment complaining of severe abdominal pain and asthenia. Surgeons, radiologists and oncologists should always keep in mind this rare adverse event during Regorafenib administration. Appropriate diagnostic tests and treatments should be carried out.
瑞戈非尼是一种多激酶抑制剂，被批准用于治疗转移性结直肠癌（mCRC）和胃肠道间质瘤（GIST）患者，这些患者在接受其他酪氨酸激酶抑制剂（如伊马替尼和舒尼替尼）治疗后出现病情进展。在接受多激酶抑制剂治疗的患者中，文献中仅描述了少数严重副作用，如肠穿孔和瘘管。我们报告一例接受瑞戈非尼治疗期间发生肠穿孔的腹膜转移性结直肠癌患者，并对相关文献进行回顾。一名48岁男性，既往乙状结肠癌已切除，正在接受瑞戈非尼治疗的腹膜转移性疾病患者，因严重腹痛和乏力就诊于我院急诊科。腹部X线和增强CT检查显示肠穿孔。患者接受了急诊手术，术中发现急性弥漫性腹膜炎、坏死以及受腹膜转移性疾病影响的回肠远端肠袢穿孔。肠壁上腹膜转移瘤的坏死可被视为导致接受瑞戈非尼治疗且出现严重腹痛和乏力的转移性结直肠癌患者发生肠穿孔的一个潜在因素。外科医生、放射科医生和肿瘤学家在瑞戈非尼给药期间应始终牢记这一罕见不良事件。应进行适当的诊断检查和治疗。
