Abstract: SA-PO170
Severe Placental Insufficiency 3 Years After Treatment with Bevacizumab: An Epigenetic Effect?
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Author
- Pagniez, Dominique C., Centre Hospitalier Universitaire, Lille, Hauts de France , France
Introduction
We report on a patient whose second pregnancy was complicated by severe intra uterine growth retardation and early preeclampsia with the HELLP syndrome, three years after she had been treated with Bevacizumab for breast cancer.
Case Description
A 26-year-old patient had had an uneventful first pregnancy in 1998. Ten years later, she was diagnosed with grade I intra ductal triple negative breast carcinoma, and treated with partial mastectomy, chemotherapy associated with Bevacizumab, and radiotherapy. Three years later, bilateral ovariectomy was about to be performed, when an unexpected pregnancy was found at echography. The patient elected to pursue this pregnancy. Severe intra uterine growth retardation occurred, and cesarean section had to be performed at 29 weeks of amenorrhea, because of preeclampsia with the HELLP syndrome. Four months later, blood pressure and renal function were normal, and there was no proteinuria. No congenital or acquired thrombophilia was found.
Discussion
Our patient had severe placental insufficiency during her second pregnancy, three years after treatment with conventional chemotherapy and Bevacizumab for breast cancer. Conventional chemotherapy, even if used during pregnancy, is not associated with an increased risk of preeclampsia (1). In non-pregnant patients, Bevacizumab may induce a preeclampsia-like syndrome, which disappears when treatment is stopped (2). In our patient, one may speculate that former bevacizumab treatment caused a long-lasting alteration of the balance of angiogenic and antiangiogenic factors, which was later revealed during pregnancy, a distinctly unusual event in that context. Antiangiogenic drugs can alter the transcription profile of acetylation genes in retinal cells (3).
This very unusual observation supports the hypothesis that Bevacizumab may have long-lasting endothelial effects through epigenetic pathways.
(1) Massey Skatulla L et al. Arch Gynecol Obstet 2012 ; 286 : 89-92
(2) Cross SN et al. Rev Obst Gynecol 2012; 5: 2-8
(3) Hamid MA et al. Ophtalmic Surg Lasers Imaging Retina 2018 ; 49 : S29-33