Paclitaxel-Induced Bowel Perforation: A Rare Cause of Acute Abdomen

Shaikh, Danial; Baiomi, Ahmed; Mehershahi, Shehriyar; Abbas, Hafsa; Gongati, Sudharshan; Nayudu, Suresh Kumar

doi:10.1159/000510131

Cited by 9 publications

(5 citation statements)

References 32 publications

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“…Bowel perforation is a rare but serious complication of malignancies, with mortality rates up to 21%, even after source control surgery 21. While there are no established predictors of bowel perforation in malignancy, tumour factors, choice and dose of chemotherapeutic drugs and patient comorbidities are thought to increase risk.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the high turnover of intestinal mucosa the GI tract is especially susceptible to the adverse effects of chemotherapeutic agents 27. Chemotherapeutic agents that are frequently implicated with bowel perforations include bevacizumab and paclitaxel, especially when coadministered with steroids 21 24 28 29. Bevacizumab is a vascular endothelial growth factor inhibitor, and its adverse effects are mediated by antiangiogenic and thrombotic effects leading to bowel ischaemia and necrosis 30.…”

Section: Discussionmentioning

confidence: 99%

“…At sites of pre-existing bowel inflammation including diverticulitis or ulceration, dual administration may create a nidus for perforation 24 28. The chemotherapy agent paclitaxel, on the other hand, has direct effects on intestinal mucosal cells causing mitotic arrest, cell death and necrotic bowel perforation 21 29. Coadministration of either of these agents with steroids appears to increase risk of bowel perforation.…”

Section: Discussionmentioning

confidence: 99%

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Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis

et al. 2022

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Osteosarcoma is the most common paediatric and adolescent primary bone malignancy and is highly chemosensitive. Gastrointestinal metastases from osteosarcomas are rare. Bowel perforation secondary to chemotherapy is a potential serious complication reported in ovarian, colorectal and haematological malignancies. We report the first documented case of chemotherapy-mediated bowel perforation in an osteosarcoma patient with gastrointestinal metastases. A man in his 20s, with a history of resected osteosarcoma in remission, presented with abdominal pain. A computed tomography (CT) scan demonstrated a large calcified intrabdominal mass (15×13×9 cm) consistent with new peritoneal disease. After one cycle of palliative ifosfamide and etoposide chemotherapy, he developed a large bowel perforation and neutropenic sepsis consequently requiring resection of the perforated mass. Chemotherapy-induced bowel perforation is a rare but serious complication that should be considered in patients with osteosarcoma, and other chemosensitive malignancies, with intra-abdominal metastases. Recommencement of systemic therapies after bowel complications must be assessed cautiously on a case-by-case basis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis

et al. 2022

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“…The presence of apoptosis of colonic epithelial cells adjacent to the site of ischemia was conspicuous in our patient suggesting that lenvatinib caused bowel perforation. Shaikh et al [ 11 ] described anticancer drug-induced apoptosis may contribute to gastrointestinal perforation and may cause this event regardless of the time and dose from the start of anticancer drug administration, whether in the small or large intestine.…”

Section: Discussionmentioning

confidence: 99%

Bowel Perforation in a Patient with Hepatocellular Carcinoma during Lenvatinib Treatment

Mizokami¹,

Watanabe²,

Yamaguchi³

et al. 2022

Case Rep Gastroenterol

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“…al. 2009;Badgwell et al 2008;Valerio et al 2021;Shaikh et al 2020]. These medications may have higher risk of causing perforation through multiple mechanisms, including impaired wound healing, wound infection, ecchymosis, dehiscence and surgical site bleeding, which further predispose to complications after surgery.…”

mentioning

confidence: 99%

Characteristics, treatment, and outcome of patients with bowel perforation after immune checkpoint inhibitor exposure

Machado

Shatila

Liu

et al. 2023

J Cancer Res Clin Oncol

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Purpose: Exposure to immune checkpoint inhibitors (ICIs) can predispose to immune-related adverse events (irAEs) involving the gastrointestinal tract. The association between ICIs and bowel perforation has not been well studied. We aimed to describe the clinical course, complications, treatment and outcomes of patients experiencing bowel perforation during or after ICI treatment.Methods: This retrospective, single-center study included adult cancer patients with bowel perforation that occurred between the rst dose of ICI treatment and up to 1 years thereafter between 1/1/2010 and 4/30/2021. Patients' clinical course, imaging, treatment and outcomes related to bowel perforation were collected and analyzed.Results: Of the 13,991 patients who received ICIs during the study period, 90 (0.6%) met the inclusion criteria. A majority were male (54.4%), the most common cancer type was melanoma (23.3%), and most patients had received PD-1/L1 inhibitor treatment (58.8%). Onset of perforation occurred after a median of 4 ICI treatment cycles. The most common symptom was abdominal pain (95.5%). The colon was the most common location for the perforation (37.7%). Evidence of diverticulitis, enterocolitis, or appendicitis was seen in 32 (35.6%) patients, and 6 (6.6%) patients had luminal cancer involvement at the time of perforation. The overall hospitalization rate related to perforation was 95.5%, with mortality of 15.5% during the same admission. Antibiotics were given in 95% of our sample; 37.8% of patients also required surgical/interventional radiology intervention. Forty-six patients (51.1%) had perforation-related complications (e.g. sepsis, stula, abscess), which were associated with a higher mortality rate (30%). Conclusion: Our ndings suggest a low incidence of bowel perforation after ICI treatment (0.6%), with 40% of patients having coexisting bowel in ammation as a potential contributing factor. Patients with bowel perforation had an aggressive disease course and high rates of hospitalization, complications and mortality. Early recognition and prompt intervention is critical to improve patient outcomes. Future studies are warranted to further investigate the cause, predictive markers and optimal treatment for this patient population.

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Paclitaxel-Induced Bowel Perforation: A Rare Cause of Acute Abdomen

Cited by 9 publications

References 32 publications

Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis

Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis

Bowel Perforation in a Patient with Hepatocellular Carcinoma during Lenvatinib Treatment

Characteristics, treatment, and outcome of patients with bowel perforation after immune checkpoint inhibitor exposure

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