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Abstract
Discussion Forum (0)
Background:
Lenvatinib, a tyrosine kinase inhibitor, works primarily by inhibiting VEGF which is an essential angiogenic factor required by cancers cells to create new vasculature. Bowel perforation has been well documented with other VEGF inhibitors although the true incidence is unknown. Pembrolizumab is an anti-human programmed cell death-1 (PD-1) monoclonal antibody which works as an immune checkpoint inhibitor. A recent study demonstrated that Lenvatinib and Pembrolizumab have antitumor activity in patients with advanced endometrial carcinoma who have experienced disease progression after prior systemic therapy.
Case:
72 year-old with recurrent Stage IVB Endometrial Carcinosarcoma undergoing treatment with Pembrolizumab and Lenvatinib who was admitted for abdominal pain. She was noted to have a distended abdomen with exquisite tenderness to light palpation with involuntary guarding. A CAT scan showed thickened wall of jejunum with new development of proximal small bowel obstruction and intraabdominal fluid and free air. The suspected diagnosis was a small bowel perforation. The patient was taken to the operating room for an emergent exploratory laparotomy and small bowel resection and anastomosis. In the abdomen, bowel contents were noted. An approximately 2mm perforation was noted in a 7cm portion of blackened ileum.
Conclusion:
Combination Lenvatinib and Pembrolizumab therapy is an FDA approved therapy for advanced endometrial cancer after failure of prior systemic therapies. VEGF inhibitors, such as Lenvatinib, are associated with a risk of bowel perforation. It is important to consider gastro-intestinal perforation in the differential diagnosis for patients presenting with abdominal pain while on Lenvatinib or other anti-angiogenic inhibitors.
Lenvatinib, a tyrosine kinase inhibitor, works primarily by inhibiting VEGF which is an essential angiogenic factor required by cancers cells to create new vasculature. Bowel perforation has been well documented with other VEGF inhibitors although the true incidence is unknown. Pembrolizumab is an anti-human programmed cell death-1 (PD-1) monoclonal antibody which works as an immune checkpoint inhibitor. A recent study demonstrated that Lenvatinib and Pembrolizumab have antitumor activity in patients with advanced endometrial carcinoma who have experienced disease progression after prior systemic therapy.
Case:
72 year-old with recurrent Stage IVB Endometrial Carcinosarcoma undergoing treatment with Pembrolizumab and Lenvatinib who was admitted for abdominal pain. She was noted to have a distended abdomen with exquisite tenderness to light palpation with involuntary guarding. A CAT scan showed thickened wall of jejunum with new development of proximal small bowel obstruction and intraabdominal fluid and free air. The suspected diagnosis was a small bowel perforation. The patient was taken to the operating room for an emergent exploratory laparotomy and small bowel resection and anastomosis. In the abdomen, bowel contents were noted. An approximately 2mm perforation was noted in a 7cm portion of blackened ileum.
Conclusion:
Combination Lenvatinib and Pembrolizumab therapy is an FDA approved therapy for advanced endometrial cancer after failure of prior systemic therapies. VEGF inhibitors, such as Lenvatinib, are associated with a risk of bowel perforation. It is important to consider gastro-intestinal perforation in the differential diagnosis for patients presenting with abdominal pain while on Lenvatinib or other anti-angiogenic inhibitors.
Background:
Lenvatinib, a tyrosine kinase inhibitor, works primarily by inhibiting VEGF which is an essential angiogenic factor required by cancers cells to create new vasculature. Bowel perforation has been well documented with other VEGF inhibitors although the true incidence is unknown. Pembrolizumab is an anti-human programmed cell death-1 (PD-1) monoclonal antibody which works as an immune checkpoint inhibitor. A recent study demonstrated that Lenvatinib and Pembrolizumab have antitumor activity in patients with advanced endometrial carcinoma who have experienced disease progression after prior systemic therapy.
Case:
72 year-old with recurrent Stage IVB Endometrial Carcinosarcoma undergoing treatment with Pembrolizumab and Lenvatinib who was admitted for abdominal pain. She was noted to have a distended abdomen with exquisite tenderness to light palpation with involuntary guarding. A CAT scan showed thickened wall of jejunum with new development of proximal small bowel obstruction and intraabdominal fluid and free air. The suspected diagnosis was a small bowel perforation. The patient was taken to the operating room for an emergent exploratory laparotomy and small bowel resection and anastomosis. In the abdomen, bowel contents were noted. An approximately 2mm perforation was noted in a 7cm portion of blackened ileum.
Conclusion:
Combination Lenvatinib and Pembrolizumab therapy is an FDA approved therapy for advanced endometrial cancer after failure of prior systemic therapies. VEGF inhibitors, such as Lenvatinib, are associated with a risk of bowel perforation. It is important to consider gastro-intestinal perforation in the differential diagnosis for patients presenting with abdominal pain while on Lenvatinib or other anti-angiogenic inhibitors.
Lenvatinib, a tyrosine kinase inhibitor, works primarily by inhibiting VEGF which is an essential angiogenic factor required by cancers cells to create new vasculature. Bowel perforation has been well documented with other VEGF inhibitors although the true incidence is unknown. Pembrolizumab is an anti-human programmed cell death-1 (PD-1) monoclonal antibody which works as an immune checkpoint inhibitor. A recent study demonstrated that Lenvatinib and Pembrolizumab have antitumor activity in patients with advanced endometrial carcinoma who have experienced disease progression after prior systemic therapy.
Case:
72 year-old with recurrent Stage IVB Endometrial Carcinosarcoma undergoing treatment with Pembrolizumab and Lenvatinib who was admitted for abdominal pain. She was noted to have a distended abdomen with exquisite tenderness to light palpation with involuntary guarding. A CAT scan showed thickened wall of jejunum with new development of proximal small bowel obstruction and intraabdominal fluid and free air. The suspected diagnosis was a small bowel perforation. The patient was taken to the operating room for an emergent exploratory laparotomy and small bowel resection and anastomosis. In the abdomen, bowel contents were noted. An approximately 2mm perforation was noted in a 7cm portion of blackened ileum.
Conclusion:
Combination Lenvatinib and Pembrolizumab therapy is an FDA approved therapy for advanced endometrial cancer after failure of prior systemic therapies. VEGF inhibitors, such as Lenvatinib, are associated with a risk of bowel perforation. It is important to consider gastro-intestinal perforation in the differential diagnosis for patients presenting with abdominal pain while on Lenvatinib or other anti-angiogenic inhibitors.
Bowel Perforation on Pembrolizumab and Lenvatinib
Gillian Chop, MD
Abstract
Discussion Forum (0)
Background:
Lenvatinib, a tyrosine kinase inhibitor, works primarily by inhibiting VEGF which is an essential angiogenic factor required by cancers cells to create new vasculature. Bowel perforation has been well documented with other VEGF inhibitors although the true incidence is unknown. Pembrolizumab is an anti-human programmed cell death-1 (PD-1) monoclonal antibody which works as an immune checkpoint inhibitor. A recent study demonstrated that Lenvatinib and Pembrolizumab have antitumor activity in patients with advanced endometrial carcinoma who have experienced disease progression after prior systemic therapy.
Case:
72 year-old with recurrent Stage IVB Endometrial Carcinosarcoma undergoing treatment with Pembrolizumab and Lenvatinib who was admitted for abdominal pain. She was noted to have a distended abdomen with exquisite tenderness to light palpation with involuntary guarding. A CAT scan showed thickened wall of jejunum with new development of proximal small bowel obstruction and intraabdominal fluid and free air. The suspected diagnosis was a small bowel perforation. The patient was taken to the operating room for an emergent exploratory laparotomy and small bowel resection and anastomosis. In the abdomen, bowel contents were noted. An approximately 2mm perforation was noted in a 7cm portion of blackened ileum.
Conclusion:
Combination Lenvatinib and Pembrolizumab therapy is an FDA approved therapy for advanced endometrial cancer after failure of prior systemic therapies. VEGF inhibitors, such as Lenvatinib, are associated with a risk of bowel perforation. It is important to consider gastro-intestinal perforation in the differential diagnosis for patients presenting with abdominal pain while on Lenvatinib or other anti-angiogenic inhibitors.
Lenvatinib, a tyrosine kinase inhibitor, works primarily by inhibiting VEGF which is an essential angiogenic factor required by cancers cells to create new vasculature. Bowel perforation has been well documented with other VEGF inhibitors although the true incidence is unknown. Pembrolizumab is an anti-human programmed cell death-1 (PD-1) monoclonal antibody which works as an immune checkpoint inhibitor. A recent study demonstrated that Lenvatinib and Pembrolizumab have antitumor activity in patients with advanced endometrial carcinoma who have experienced disease progression after prior systemic therapy.
Case:
72 year-old with recurrent Stage IVB Endometrial Carcinosarcoma undergoing treatment with Pembrolizumab and Lenvatinib who was admitted for abdominal pain. She was noted to have a distended abdomen with exquisite tenderness to light palpation with involuntary guarding. A CAT scan showed thickened wall of jejunum with new development of proximal small bowel obstruction and intraabdominal fluid and free air. The suspected diagnosis was a small bowel perforation. The patient was taken to the operating room for an emergent exploratory laparotomy and small bowel resection and anastomosis. In the abdomen, bowel contents were noted. An approximately 2mm perforation was noted in a 7cm portion of blackened ileum.
Conclusion:
Combination Lenvatinib and Pembrolizumab therapy is an FDA approved therapy for advanced endometrial cancer after failure of prior systemic therapies. VEGF inhibitors, such as Lenvatinib, are associated with a risk of bowel perforation. It is important to consider gastro-intestinal perforation in the differential diagnosis for patients presenting with abdominal pain while on Lenvatinib or other anti-angiogenic inhibitors.
Background:
Lenvatinib, a tyrosine kinase inhibitor, works primarily by inhibiting VEGF which is an essential angiogenic factor required by cancers cells to create new vasculature. Bowel perforation has been well documented with other VEGF inhibitors although the true incidence is unknown. Pembrolizumab is an anti-human programmed cell death-1 (PD-1) monoclonal antibody which works as an immune checkpoint inhibitor. A recent study demonstrated that Lenvatinib and Pembrolizumab have antitumor activity in patients with advanced endometrial carcinoma who have experienced disease progression after prior systemic therapy.
Case:
72 year-old with recurrent Stage IVB Endometrial Carcinosarcoma undergoing treatment with Pembrolizumab and Lenvatinib who was admitted for abdominal pain. She was noted to have a distended abdomen with exquisite tenderness to light palpation with involuntary guarding. A CAT scan showed thickened wall of jejunum with new development of proximal small bowel obstruction and intraabdominal fluid and free air. The suspected diagnosis was a small bowel perforation. The patient was taken to the operating room for an emergent exploratory laparotomy and small bowel resection and anastomosis. In the abdomen, bowel contents were noted. An approximately 2mm perforation was noted in a 7cm portion of blackened ileum.
Conclusion:
Combination Lenvatinib and Pembrolizumab therapy is an FDA approved therapy for advanced endometrial cancer after failure of prior systemic therapies. VEGF inhibitors, such as Lenvatinib, are associated with a risk of bowel perforation. It is important to consider gastro-intestinal perforation in the differential diagnosis for patients presenting with abdominal pain while on Lenvatinib or other anti-angiogenic inhibitors.
Lenvatinib, a tyrosine kinase inhibitor, works primarily by inhibiting VEGF which is an essential angiogenic factor required by cancers cells to create new vasculature. Bowel perforation has been well documented with other VEGF inhibitors although the true incidence is unknown. Pembrolizumab is an anti-human programmed cell death-1 (PD-1) monoclonal antibody which works as an immune checkpoint inhibitor. A recent study demonstrated that Lenvatinib and Pembrolizumab have antitumor activity in patients with advanced endometrial carcinoma who have experienced disease progression after prior systemic therapy.
Case:
72 year-old with recurrent Stage IVB Endometrial Carcinosarcoma undergoing treatment with Pembrolizumab and Lenvatinib who was admitted for abdominal pain. She was noted to have a distended abdomen with exquisite tenderness to light palpation with involuntary guarding. A CAT scan showed thickened wall of jejunum with new development of proximal small bowel obstruction and intraabdominal fluid and free air. The suspected diagnosis was a small bowel perforation. The patient was taken to the operating room for an emergent exploratory laparotomy and small bowel resection and anastomosis. In the abdomen, bowel contents were noted. An approximately 2mm perforation was noted in a 7cm portion of blackened ileum.
Conclusion:
Combination Lenvatinib and Pembrolizumab therapy is an FDA approved therapy for advanced endometrial cancer after failure of prior systemic therapies. VEGF inhibitors, such as Lenvatinib, are associated with a risk of bowel perforation. It is important to consider gastro-intestinal perforation in the differential diagnosis for patients presenting with abdominal pain while on Lenvatinib or other anti-angiogenic inhibitors.
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