Alveolar Hemorrhage Caused by the Combination of Immune Checkpoint Inhibitors (ICIs) and Angiogenesis Inhibitors: The Underlying Long-Term Vascular Endothelial Growth Factor (VEGF) Inhibition.

Autor:	Shijubou N; Respiratory Medicine, Hakodate Municipal Hospital, Hakodate, JPN., Sawai T; Respiratory Medicine, Hakodate Municipal Hospital, Hakodate, JPN., Hatakeyama T; Respiratory Medicine, Hakodate Municipal Hospital, Hakodate, JPN., Munakata S; Pathology, Hakodate Municipal Hospital, Hakodate, JPN., Yamazoe M; Respiratory Medicine, Hakodate Municipal Hospital, Hakodate, JPN.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2022 Mar 17; Vol. 14 (3), pp. e23272. Date of Electronic Publication: 2022 Mar 17 (Print Publication: 2022).
DOI:	10.7759/cureus.23272
Abstrakt:	The combination of immune checkpoint inhibitors (ICIs) and other anticancer agents is the standard of care for various cancers. Bevacizumab, an anti-angiogenesis inhibitor, causes serious adverse events such as pulmonary hemorrhage (PH). Here, we present a case of drug-induced diffuse alveolar hemorrhage (DAH), an adverse event, in a patient with hepatocellular carcinoma who was treated with a combination of ICIs and anti-angiogenesis inhibitors after long-term use of lenvatinib, which inhibits vascular endothelial growth factor (VEGF). An 85-year-old man with hepatocellular carcinoma initially received lenvatinib, a multi-kinase inhibitor, but the drug was later switched to bevacizumab-atezolizumab combination therapy owing to disease progression. After five cycles, he developed dyspnea and diffuse ground-glass opacities, which improved with discontinuation of the combination therapy and initiation of steroid pulse therapy. Our case findings indicate that both ICIs and anti-angiogenesis inhibitors cause drug-induced DAH, and their combination may increase the severity of DAH. Moreover, long-term VEGF inhibition may induce the development of DAH. Clinicians need to be aware that long-term VEGF inhibition may be associated with DAH and should consider the risk management of such adverse events while using this combination therapy. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2022, Shijubou et al.)
Databáze:	MEDLINE
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