(author: Dr. Y. Pan) Cardiovascular Toxicity of Bevacizumab in Long-term Survival of Recurrent Ovarian Cancer: A Case Report

open access - case report

Cardiovascular Toxicity of Bevacizumab in Long-term Survival of
Recurrent Ovarian Cancer: A Case Report
Yi Pan1
1 Department of Neurology, School of Medicine, Saint Louis University, St. Louis, MO, USA
Correspondence: Yi Pan, MD, Ph.D, Associate Professor, Departmetn of Neurology, School of Medicine, Saint Louis University 1438 South Grand Boulevard, St. Louis, MO 63104, USA.
Published: July 18, 2016

The present case may represent many recurrent ovarian cancer patients who have benefited greatly from emerging target therapies, such as bevacizumab, and have survived longer with an improved quality of life, but also later developed adverse effects including cardiovascular disease.

 To reap the benefits of long term bevacizumab treatment, efforts should be made to diagnose cardiovascular complications and to treat them aggressively to minimize the deleterious adverse effects of cancer therapy.

Introduction: Bevacizumab has been shown to improve progression-free survival in women with ovarian cancer in multiple clinical trials. Cardiovascular toxicity is reported in the case of a long term survivor of recurrent ovarian cancer.  

Case Report: A 47-year-old woman was diagnosed as stage IIIC, Grade 3 endometrioid adenocarcinoma of the ovary. She had been treated with 4 debulking surgeries and 6 different chemotherapy regimens for 9 years. However, remission diminished over this time period to only one month. Bevacizumab was

administrated with additional chemotherapies, and prolonged survival was demonstrated over the next 5 years, including ongoing remission of 18 months to date. New onset hypertension was developed at the 10th month of

bevacizumab treatment, and proteinuria was found at the 12th month. Patient presented symptoms of coronary artery disease during the 31th month of bevacizumab treatment, and was soon treated with 4 stents, whereby

symptoms resolved. After the 36th month of bevacizumab, the patient had non ST elevated myocardial infarction and peripheral vascular disease. Bevacizumab was terminated thereafter. In the following 18 months, the patient was treated with angioplasty 2 times for coronary artery occlusion, and with an additional stent. This was followed with coronary artery bypass graft. She also had an angioplasty for right femoral artery stenosis. Throughout most of the 14 year disease course, the patient maintained a good quality of life. As patients achieve long term survival from bevacizumab treatment, cardiovascular complications should be recognized and treated aggressively to minimize the adverse effects of cancer therapy.

1. Introduction

Bevacizumab is a vascular endothelial growth factor (VEGF) inhibitor. It has improved progression-free survival in women with ovarian cancer in both first-line chemotherapy (GOG-0218 and ICON7 trials), and second-line

chemotherapy in platinum-sensitive (OCEANS trial) and platinum-resistant (AURELIA trial) recurrent ovarian cancer (Burger et al., 2011; Perren et al., 2011; Aghajanian et al., 2012; Pujade-Lauraine et al., 2014). The Food and Drug Administration (FDA) approved bevacizumab for the treatment of patients with platinum-resistant recurrent ovarian cancer in combination with paclitaxel or one other chemotherapy regiment in 2014. The most common vascular toxicities of bevacizumab, from those clinical trials, are hypertension and proteinuria.

Coronary artery and peripheral artery diseases as vascular toxicities of bevacizumab are lacking in the literature, which may be due to limited long-term follow up…...