Title: Challenges in Cardioncology: Aortic Dissection after Cancer Treatment with Angiogenesis Inhibitors

Abstract:

Statement of the Problem:

As the general life expectancy of the population has increased, we have noticed that patients have more and more common risk factors for developing cardiovascular disease and cancer. Furthermore, despite advances in cancer therapies, there are still a variety of cardiotoxic adverse effects of treatment. Vascular endothelial growth factor inhibitors (VEGFI), such as bevazizumab, are widely used in cancer treatments, with a good clinical response. However, although there are still gaps in the available data, bevazizumab has been associated with adverse effects such as hypertension and endothelial dysfunction, including acute aortic disease. Case Report: 76-year-old female patient with  hypertension under control, aortic arch dilation of 4.8cm (stable for 2 years) and right colon adenocarcinoma metastatic to the lymph node and liver. Chemotherapy was started with oxaliplatin, folinic acid and 5-fluorouracil, associated with bevazizumab. After the sixth cycle, the patient developed a sudden episode of intense chest discomfort, sweating and dizziness. In the emergency room, the initial diagnostic hypothesis was acute coronary syndrome secondary to vasospasm caused by 5-fluoracil. On physical examination, a difference in blood pressure was detected in the upper limbs, and aortic dissection was hypothesized. Chest tomography confirmed the diagnosis of type A aortic dissection. She underwent emergency surgery to replace the ascending aorta with suspension of the aortic valve, total aortic arch replacement, brachiocephalic trunk reimplantation and left common carotid artery reimplantation with interposition. The procedure was uneventful. The patient was discharged after 26 days of hospitalization with no neurological or motor sequelae and a ventricular ejection fraction of 39%.

Conclusion & Significance:

Our report aims to draw attention to the need for cardiovascular monitoring and appropriate management of patients taking bevazizumab.

Biography:

Juliana Soares is a cardiologist with a postgraduate degree in cardiology and women's cardiology. Founder of the Cardioncology Service at the Federal University of São Paulo - Brazil. She was head of the medical assistance groups at Hospital Israelita Albert Einstein. Author of several book chapters. Awarded Outstanding Achievement in Cardiology in 2014 by the MD Anderson Cancer Center. Lecturer in postgraduate Cardiology at Hospital Israelita Albert Einstein.

Title: Challenges in Cardioncology: Aortic Dissection after Cancer Treatment with Angiogenesis Inhibitors

Abstract:

Statement of the Problem:

As the general life expectancy of the population has increased, we have noticed that patients have more and more common risk factors for developing cardiovascular disease and cancer. Furthermore, despite advances in cancer therapies, there are still a variety of cardiotoxic adverse effects of treatment. Vascular endothelial growth factor inhibitors (VEGFI), such as bevazizumab, are widely used in cancer treatments, with a good clinical response. However, although there are still gaps in the available data, bevazizumab has been associated with adverse effects such as hypertension and endothelial dysfunction, including acute aortic disease. Case Report: 76-year-old female patient with  hypertension under control, aortic arch dilation of 4.8cm (stable for 2 years) and right colon adenocarcinoma metastatic to the lymph node and liver. Chemotherapy was started with oxaliplatin, folinic acid and 5-fluorouracil, associated with bevazizumab. After the sixth cycle, the patient developed a sudden episode of intense chest discomfort, sweating and dizziness. In the emergency room, the initial diagnostic hypothesis was acute coronary syndrome secondary to vasospasm caused by 5-fluoracil. On physical examination, a difference in blood pressure was detected in the upper limbs, and aortic dissection was hypothesized. Chest tomography confirmed the diagnosis of type A aortic dissection. She underwent emergency surgery to replace the ascending aorta with suspension of the aortic valve, total aortic arch replacement, brachiocephalic trunk reimplantation and left common carotid artery reimplantation with interposition. The procedure was uneventful. The patient was discharged after 26 days of hospitalization with no neurological or motor sequelae and a ventricular ejection fraction of 39%.

Conclusion & Significance:

Our report aims to draw attention to the need for cardiovascular monitoring and appropriate management of patients taking bevazizumab.

Biography:

Juliana Soares is a cardiologist with a postgraduate degree in cardiology and women's cardiology. Founder of the Cardioncology Service at the Federal University of São Paulo - Brazil. She was head of the medical assistance groups at Hospital Israelita Albert Einstein. Author of several book chapters. Awarded Outstanding Achievement in Cardiology in 2014 by the MD Anderson Cancer Center. Lecturer in postgraduate Cardiology at Hospital Israelita Albert Einstein.