Kosin Medical Journal

Case reports

Brain hemorrhage in patients with advanced hepatocellular carcinoma treated with atezolizumab and bevacizumab: two case reports: Bangju Kim, Hyun Joon Park, Sang Uk Lee, Kwang Il Seo, Jung Wook Lee, Sumin Jo, Jun Yeb Nam; Kosin Med J. 2025;40(2):150-156. Published online June 30, 2025; DOI: https://doi.org/10.7180/kmj.25.114

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Abstract PDF PubReader ePub: A combination of atezolizumab and bevacizumab is currently recommended for treating unresectable advanced-stage hepatocellular carcinoma (HCC), as it has demonstrated superior overall survival and progression-free survival compared to sorafenib. However, concerns have been raised regarding serious adverse events associated with bevacizumab, such as gastrointestinal perforation, fistula, hemorrhage, and arterial thromboembolism. In particular, patients with liver cirrhosis (LC) show an increased risk of variceal bleeding. However, brain hemorrhage associated with the use of bevacizumab in patients with HCC and LC is extremely rare. We encountered two cases of brain hemorrhage in patients with HCC and LC who underwent treatment with atezolizumab and bevacizumab. One patient had no history of hypertension, while the other patient had hypertension that was well-controlled with medication and an unruptured brain aneurysm located on the right side of the anterior communicating artery. Both patients experienced brain hemorrhage after two treatment cycles of atezolizumab with bevacizumab. One patient died due to brain hemorrhage, while the other patient recovered from subarachnoid hemorrhage with successful coil embolization. This case report suggests that if a patient has any high-risk factors associated with brain hemorrhage, physicians should thoroughly consider alternative treatment options for advanced HCC, as brain hemorrhage could be fatal.

Drug-induced immune-mediated thrombocytopenia due to bevacizumab-FOLFOX therapy: a case report: Minna Kim, Jong Hoon Lee, Jong Yoon Lee; Kosin Med J. 2023;38(4):300-306. Published online July 28, 2023; DOI: https://doi.org/10.7180/kmj.23.121

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Abstract PDF PubReader ePub: Drug-induced immune thrombocytopenia (DITP) is a very rare disease, with an estimated annual incidence of 10 cases per million. Oxaliplatin and irinotecan are widely used as chemotherapy for high-risk stage II and III colorectal cancer, and DITP has been reported to occur in patients using those agents. To treat unresectable metastatic colorectal cancer, bevacizumab is used in combination with oxaliplatin or irinotecan, and there have been a few reports of DITP cases in patients receiving that regimen. In this report, we describe a 68-year-old male patient with metastatic colon cancer (KRAS mutant type) to the liver and lung who developed acute immune-mediated thrombocytopenia due to bevacizumab-FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) therapy. During treatment, he showed purpura in his lower extremities on 21st cycle day 2. Lab work revealed a platelet count of less than 2,000/mL, reflecting a decrease from 135,000/mL at the start of the cycle 1 day prior. He did not have any other types of cytopenia or significant changes in laboratory findings. We diagnosed DITP due to bevacizumab-FOLFOX, and the patient did not show isolated thrombocytopenia after switching to Ziv-aflibercept-FOLFIRI (5-fluorouracil, leucovorin, and irinotecan).

Original articles

Revascularization of immature retinas with retinopathy of prematurity using combination therapy of deferred laser treatment after a single intravitreal bevacizumab injection: Ju Seouk Lee, Ki Yup Nam, Ji Eun Lee, Joo Eun Lee, Sang Joon Lee; Kosin Med J. 2023;38(1):28-35. Published online March 28, 2023; DOI: https://doi.org/10.7180/kmj.22.145

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Background
This study aimed to observe the extent of retinal vascularization in patients with retinopathy of prematurity (ROP) who underwent deferred laser treatment (LT) after a single intravitreal bevacizumab injection (IVB).
Methods
This study retrospectively evaluated 40 consecutive eyes in 21 infants who received a single IVB or LT. Deferred LT was performed in cases of ROP recurrence after a single IVB. To assess the amount of retinal vascularization between the initial IVB and deferred LT, the cases were divided into three groups based on treatment: single IVB, deferred LT after a single IVB, and prompt LT. The growth and associated complications were compared between groups.
Results
There were 12, 16, and 12 eyes in the single IVB, deferred LT, and prompt LT groups, respectively. Deferred LT was performed at an average of 7.9 weeks after a single IVB. In the single IVB group, retinal vascularization proceeded to zone III, whereas the prompt LT group did not show any growth of vascularization beyond the laser scars. In the deferred LT group, during the window period before LT, retinal vascularization progressed from zone I to zone II posterior and from zone II posterior to zone II anterior, respectively, without further ROP recurrence.
Conclusions
Retinal vascularization progressed during the deferred window period, thereby reducing the area of the retina ablated by LT. A single IVB followed by deferred LT can be an alternative treatment option to prevent ablation of zone I or multiple IVBs.

Citations

Citations to this article as recorded by

Comparison of different agents and doses of anti-vascular endothelial growth factors (aflibercept, bevacizumab, conbercept, ranibizumab) versus laser for retinopathy of prematurity: A network meta-analysis
Amparo Ortiz-Seller, Pablo Martorell, Honorio Barranco, Isabel Pascual-Camps, Esteban Morcillo, José L. Ortiz
Survey of Ophthalmology.2024;[Epub] CrossRef
What is the effect of deferred laser treatment on reactivated retinopathy of prematurity after anti-VEGF injection?
Ji Hye Jang
Kosin Medical Journal.2023; 38(1): 1. CrossRef

Retrospective analysis on the clinical efficacy of bevacizumab combined with FOLFOX4 in the first line treatment of metastatic colorectal cancer: Eun Mi Lee, Lee Chun Park, Ho Sup Lee, Seong Hoon Shin, Yang Soo Kim; Kosin Med J. 2017;32(2):170-178. Published online January 19, 2017; DOI: https://doi.org/10.7180/kmj.2017.32.2.170

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Abstract PDF PubReader ePub: Objectives
The addition of bevacizumab to standard chemotherapy has been improved survival outcomes in patients with metastatic colorectal cancer. However, the combination of bevacizumab with oxaliplatin-based chemotherapy as first-line treatment showed limited survival benefit. The purpose of this study was to investigate the clinical efficacy and toxicity of the combination of bevacizumab to oxaliplatin and leucovorin (FOLFOX4) in the first-line treatment of patient with metastatic colorectal cancer.
Methods
Between December 2004 and September 2009, medical records of patients who were diagnosed with metastatic colorectal cancer and received the first line chemotherapy with bevacizumab and FOLFOX4, were retrospectively reviewed.
Results
A total of forty patients were analyzed. The median age of the patients was 55 years (range, 33-80), and 55% was male. The patients received a total of 206 cycles of therapy (median 4 cycles per patient; range 1 – 15 cycles). Of these 40 patients, none achieved complete response (CR) and 15 achieved a partial response (PR), for the overall response rate (ORR) 37.5% (95% CI, 22.5-52.5). Median progression free survival (PFS) was 6.9 months (95% CI, 3.4-10.5) and median overall survival (OS) was 22.6 months (95% CI, 17.3-27.8The most common grade 3 or 4 hematologic toxicity and non-hematologic toxicity were neutropenia (10.0%) and diarrhea (10.0%), respectively. Two patients experienced gastrointestinal perforation.
Conclusions
In this study, the combination bevacizumab with FOLFOX4 was associated with favorable OS, but did not showed favorable PFS and ORR.

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