Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jul 24, 2020; 11(7): 504-509
Published online Jul 24, 2020. doi: 10.5306/wjco.v11.i7.504
Mechanisms and anatomical risk factors of pneumothorax after Bevacizumab use: A case report
Yuri Ozaki, Akiyo Yoshimura, Masataka Sawaki, Masaya Hattori, Naomi Gondo, Haruru Kotani, Yayoi Adachi, Ayumi Kataoka, Kayoko Sugino, Nanae Horisawa, Yuka Endo, Kazuki Nozawa, Shoko Sakamoto, Hiroji Iwata
Yuri Ozaki, Akiyo Yoshimura, Masataka Sawaki, Masaya Hattori, Naomi Gondo, Haruru Kotani, Yayoi Adachi, Ayumi Kataoka, Kayoko Sugino, Nanae Horisawa, Yuka Endo, Kazuki Nozawa, Shoko Sakamoto, Hiroji Iwata, Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
Author contributions: Ozaki Y contributed to study conception, data collection, and manuscript writing; Yoshimura A and Iwata H supervised the study and revised the manuscript before submission; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of personal details and accompanying images in this manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests in relation to the present work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yuri Ozaki, MD, Surgical Oncologist, Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 kanoko-den chikusa-ku Nagoya City, Aichi, Nagoya 464-8681, Japan. yozaki@aichi-cc.jp
Received: February 14, 2020
Peer-review started: February 14, 2020
First decision: May 28, 2020
Revised: June 2, 2020
Accepted: June 10, 2020
Article in press: June 10, 2020
Published online: July 24, 2020
Processing time: 156 Days and 20.1 Hours
Abstract
BACKGROUND

Bevacizumab is an antiangiogenic agent, and that synergizes with chemotherapeutic drugs. When used in combination therapies, Bevacizumab is associated with adverse events such as hemorrhage, gastrointestinal perforation, delayed wound healing, and pneumothorax. However, the molecular mechanisms underlying these adverse events are not fully understood.

CASE SUMMARY

A 45-year-old female with multiple lung metastases that were derived from primary breast cancer, was placed on Bevacizumab + paclitaxel therapy, since this combination has a potent antitumor effect. She reported dyspnea before cycle 3, day 1 and we therefore ran a chest X-ray, which detected a right pneumothorax. The coronal plane computed tomography revealed that one solid mass rapidly necrosed and was replaced by a cavity that passed through the bronchus in the right lower lobe. The cavity eventually ruptured the pleura and made the bronchopleural fistula that led to this pneumothorax. Thoracic cavity drainage using an intercostal catheter was performed. On the 7th day of drainage, the patient was discharged from our hospital on recovery. Recurrence of pneumothorax was not reported, and continuation of chemotherapy was made possible by changing the regimen.

CONCLUSION

Patients with lung metastases surrounding the bronchi and on the pleura should be monitored for pneumothorax by Bevacizumab-containing chemotherapies.

Keywords: Breast cancer; Lung metastasis; Bevacizumab; Adverse event; Pneumothorax; Case report

Core tip: Combination therapy with Bevacizumab and chemotherapy is used to expect its high antitumor effect. However, Bevacizumab-containing combination therapies can induce severe adverse events. Mechanisms and risk factors that underlie the onset of pneumothorax are not clear. Here, we report a case of pneumothorax associated with a combination therapy of Bevacizumab with chemotherapy, and discuss the mechanisms and risk factors. Patients with multiple lung metastases surrounding the bronchi and on the pleura, should be monitored for pneumothorax, an adverse event that can be induced by the rapid necrosis due to Bevacizumab-containing combination chemotherapies.