Kosin Med J.  2023 Dec;38(4):300-306. 10.7180/kmj.23.121.

Drug-induced immune-mediated thrombocytopenia due to bevacizumab-FOLFOX therapy: a case report

• Kim M
• Lee JH
• Lee JY

• KMID: 2549504
• DOI: http://doi.org/10.7180/kmj.23.121

Abstract

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).

Keyword

Bevacizumab; Chemotherapy; Colorectal neoplasms; Oxaliplatin; Thrombocytopenia

Figure

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  Fig. 1. Sigmoidoscopy showed an obstruction due to a mass in the sigmoid colon. (A) A self-expandable metal stent (SEMS) was inserted. (B) Fluoroscopy showed the successful placement of SEMS. (C) An abdominal X-ray confirmed the successful placement of the SEMS (arrow).

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  Fig. 2. Abdominal computed tomography. (A, B) Metastatic lesions (arrow) in the lung and liver. (C, D) Laparoscopic anterior resection and metastasectomy of the liver and lung were performed; however, residual cancer remained at the site of hepatic metastasectomy after the operation (arrow).

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  Fig. 3. The appearance of purpura on the patient's extremities. (A, B) On day 3 (cycle day 2), purpura was observed in the lower extremities. (C) On day 6, the purpura in the lower extremities was relieved.

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  Fig. 4. Lab work demonstrated a platelet count of less than 2x103/μL, reflecting a decrease from 135x103/μL at the start of the cycle 1 day prior. On day 12 (outpatient department), the platelet count returned to the normal range.

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  Fig. 5. Confirmation of progressive disease was achieved through comparison with the previous abdominal computed tomography. (A) After the 18th cycle of chemotherapy, an abdominal computed tomography scan revealed a soft tissue mass-like lesion (arrow) adjacent to the S8 wedge. (B) After the 21st cycle of chemotherapy, another abdominal computed tomography scan showed an increased extent of the soft tissue mass-like lesion (arrow), extending from the S8 wedge resection site to the hilum.

Reference

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