贝伐珠单抗联合FOLFIRI方案治疗晚期直肠癌并发直肠阴道瘘1例报告及文献复习

doi:10.13481/j.1671-587X.20220329

Abstract

Abstract: Objective

To investigate the efficacy of bevacizumab combined with chemotherapy in the treatment of the rectal cancer patients with rectovaginal fistula，and to provide the reference basis for the treatment of the disease.

Methods

The clinical data of one patient with advanced rectal cancer with rectovaginal fistula treated with bevacizumab combined with FOLFIRI were collected，and the characteristics and process of diagnosis and treatment were analyzed； the relevant literatures were summarized at the same time.

Results

A 64-year-old female patient received transabdominal rectal cancer surgery （Dixon surgery） in People’s Hospital of Jilin Province，and the postoperative pathological results showed moderately differentiated rectal adenocarcinoma，invasion of posterior wall of vagina and regional lymph node metastasis （pT4bN2M0， Stage ⅢC，Dukes C）；the immunohistochemistry results showed MHS2（+），MLH1（+），PMS2（+），MSH6（+），S-100（－），and BRAFV600E（－），indicating proficiency of mismatch repair（pMMR）；the patient had N- and K-RAS gene mutations.The pelvic MRI results at 4 weeks after surgery revealed the postoperative rectovaginal fistula before pre-adjuvant chemotherapy.The chemotherapy was postponed， and the disease continued to progress 5 months after surgery， and the palliative first-line and second-line chemotherapy were perfermed under compulsion.However， the disease continued to progress， and the third-line chemotherapy of bevalizumab combined with FOLFIRI regimen was performed and did not aggravate the rectovaginal fistula， and promoted the fistula healing，while significantly improved the quality of life of the patient.

Conclusion

Bevacizumab combined with chemotherapy is a feasible treatment option for the rectal cancer patients with rectovaginal fistula caused by the tumor progression and will not benefit from the cetuximab therapy.

Key words: Rectal neoplasm, Bevacizumab, Adjuvant chemotherapy, Rectovaginal fistula, Clinical partial response, Case report

CLC Number:

R730.6

Junjie HOU,Xuguang MI,Xiaonan LI,Xiaonan LI,Ying YANG,Xianzhuo JIANG,Ying ZHOU,Zhiqiang NI,Ningyi JIN,Yanqiu FANG. Treatment of advanced rectal cancer with rectovaginal fistula through bevacizumab combined with FOLFIRI regimen: A case report and literature review[J].Journal of Jilin University(Medicine Edition), 2022, 48(3): 790-795.

Figures/Tables 4

References 23

1	CERCEK A， ROXBURGH C S D， STROMBOM P， et al. Adoption of total neoadjuvant therapy for locally advanced rectal cancer［J］. JAMA Oncol， 2018， 4（6）： e180071.
2	LEE J H， LEE J H， AHN J H， et al. Randomized trial of postoperative adjuvant therapy in stage Ⅱ and Ⅲ rectal cancer to define the optimal sequence of chemotherapy and radiotherapy： a preliminary report［J］. J Clin Oncol， 2002， 20（7）： 1751-1758.
3	FELIU J， SALUD A， SAFONT M J， et al. First-line bevacizumab and capecitabine-oxaliplatin in elderly patients with mCRC： GEMCAD phase Ⅱ BECOX study［J］. Br J Cancer， 2014， 111（2）： 241-248.
4	TEBBUTT N C， WILSON K， GEBSKI V J， et al. Capecitabine， bevacizumab， and mitomycin in first-line treatment of metastatic colorectal cancer： results of the Australasian Gastrointestinal Trials Group Randomized Phase Ⅲ MAX Study［J］. J Clin Oncol， 2010， 28（19）： 3191-3198.
5	CUNNINGHAM D， LANG I， MARCUELLO E，et al. Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer （AVEX）： an open-label， randomised phase 3 trial［J］. Lancet Oncol，2013，14（11）：1077-1085.
6	GARCIA J， HURWITZ H I， SANDLER A B， et al. Bevacizumab （Avastin®） in cancer treatment： a review of 15 years of clinical experience and future outlook［J］. Cancer Treat Rev， 2020， 86： 102017.
7	徐圣君，赵晓平. 胸腺法新联合抗生素用于恶性肿瘤并发肺部感染的疗效观察［J］. 中国肿瘤临床与康复， 2019， 26（9）： 1073-1076.
8	KOSUGI C， SAITO N， KIMATA Y， et al. Rectovaginal fistulas after rectal cancer surgery： incidence and operative repair by gluteal-fold flap repair［J］. Surgery， 2005， 137（3）： 329-336.
9	NAKAGOE T， SAWAI T， TUJI T， et al. Successful transvaginal repair of a rectovaginal fistula developing after double-stapled anastomosis in low anterior resection： report of four cases［J］.Surg Today， 1999，29（5）： 443-445.
10	YUAN F， CHEN Y， DELLIAN M， et al. Time-dependent vascular regression and permeability changes in established human tumor xenografts induced by an anti-vascular endothelial growth factor/vascular permeability factor antibody［J］. Proc Natl Acad Sci U S A， 1996， 93（25）： 14765-14770.
11	BATCHELOR T T， SORENSEN A G， DI TOMASO E， et al. AZD2171， a pan-VEGF receptor tyrosine kinase inhibitor， normalizes tumor vasculature and alleviates edema in glioblastoma patients［J］. Cancer Cell， 2007， 11（1）： 83-95.
12	JAIN R K. Normalization of tumor vasculature： an emerging concept in antiangiogenic therapy［J］. Science， 2005， 307（5706）： 58-62.
13	TURLEY R S， FONTANELLA A N， PADUSSIS J C，et al. Bevacizumab-induced alterations in vascular permeability and drug delivery： a novel approach to augment regional chemotherapy for in-transit melanoma［J］.Clin Cancer Res，2012，18（12）：3328-3339.
14	SETO T， KATO T， NISHIO M， et al. Erlotinib alone or with bevacizumab as first-line therapy in patients with advanced non-squamous non-small-cell lung cancer harbouring EGFR mutations （JO25567）： an open-label， randomised， multicentre， phase 2 study［J］. Lancet Oncol， 2014， 15（11）： 1236-1244.
15	HURWITZ H I， FEHRENBACHER L， HAINSWORTH J D， et al. Bevacizumab in combination with fluorouracil and leucovorin： an active regimen for first-line metastatic colorectal cancer［J］. J Clin Oncol， 2005， 23（15）： 3502-3508.
16	BENNOUNA J， SASTRE J， ARNOLD D， et al. Continuation of bevacizumab after first progression in metastatic colorectal cancer （ML18147）： a randomised phase 3 trial［J］. Lancet Oncol， 2013， 14（1）： 29-37.
17	EMMANOUILIDES C， SFAKIOTAKI G， ANDROULAKIS N， et al. Front-line bevacizumab in combination with oxaliplatin， leucovorin and 5-fluorouracil （FOLFOX） in patients with metastatic colorectal cancer： a multicenter phase Ⅱ study［J］. BMC Cancer， 2007， 7： 91.
18	DOUILLARD J Y， SIENA S， CASSIDY J， et al. Randomized， phase III trial of panitumumab with infusional fluorouracil， leucovorin， and oxaliplatin （FOLFOX4） versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer： the PRIME study［J］. J Clin Oncol， 2010， 28（31）： 4697-4705.
19	BENSON A B， VENOOK A P， AL-HAWARY M M， et al. Rectal cancer， version 2.2018， NCCN clinical practice guidelines in oncology［J］. J Natl Compr Canc Netw， 2018， 16（7）： 874-901.
20	GORDON M S， CUNNINGHAM D. Managing patients treated with bevacizumab combination therapy［J］. Oncology， 2005， 69（）： 25-33.
21	CHÉREAU E， STEFANESCU D， SELLE F， et al. Spontaneous rectovaginal fistula during bevacizumab therapy for ovarian cancer： a case report［J］. Am J Obstet Gynecol， 2009， 200（1）： e15-e16.
22	LEY E J， VUKASIN P， KAISER A M， et al. Delayed rectovaginal fistula： a potential complication of bevacizumab （avastin）［J］.Dis Colon Rectum，2007，50（6）： 930.
23	GALANOPOULOS M， LADIAS S， TZANNETAKOU X，et al. A rectovaginal fistula after treatment with bevacizumab. A dangerous side effect needing emergency treatment［J］. Clin Case Rep， 2016， 4（4）： 449-450.

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Treatment of advanced rectal cancer with rectovaginal fistula through bevacizumab combined with FOLFIRI regimen: A case report and literature review

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