Abstract: PUB152
Nephrotic Syndrome and Pulmonary Hypertension After Bevacizumab in a Woman with Intrahepatic Cholangiocarcinoma
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Li, Aimei, Central South University Third Xiangya Hospital Department of Nephrology, Changsha, Hunan, China
- Li, Ling, Central South University Third Xiangya Hospital Department of Nephrology, Changsha, Hunan, China
- Zhang, Dong Dong, Central South University Third Xiangya Hospital Department of Nephrology, Changsha, Hunan, China
- Yi, Bin, Central South University Third Xiangya Hospital Department of Nephrology, Changsha, Hunan, China
Introduction
Inhibition of vascular endothelial growth factor A (VEGFA)/vascular endothelial growth factor receptor 2 (VEGFR2) signaling is a common therapeutic strategy in oncology, Bevacizumab, or avastin, is a monoclonal hybrid antibody that binds to and neutralizes vascular endothelial growth factor. It has shown promising efficacy in the adjunctive treatment of patients with several cancers. Several reports indicated that bevacizumab therapy often was associated with the development of proteinuria. Reports of pulmonary hypertension following treatment with bevacizumab are limited, and no reports of concurrent nephrotic syndrome and pulmonary arterial hypertension have been described.
Case Description
A 37-year-old female developed new-onset nephrotic syndrome in association with bevacizumab (19 cycle) and Sintilimab (22 cycle) treatment for Intrahepatic cholangiocarcinoma (ICC). Renal biopsy showed an immune-complex-mediated Endocapillary Proliferative Glomerulonephritis. Nephrotic syndrome was improved after glucocorticoids treatment and discontinuation of bevacizumab therapy for 3 months. However, pulmonary arterial hypertension (pulmonary artery pressure (PAP) of 71 mmHg) and heart failure occurred after two years of continued bevacizumab (19cycle) therapy, and the condition improved following discontinuation of bevacizumab and administration of anti-pulmonary arterial hypertension therapy.
Discussion
This is the first reported case of concurrent nephrotic syndrome and pulmonary arterial hypertension following the use of bevacizumab, but the underlying mechanism remains unclear and requires additional investigation. Clinicians should be aware of the potential nephrotoxicity and cardiotoxicity of bevacizumab and should monitor urine protein excretion and echocardiography closely during therapy with this agent.