Bevacizumab-Associated Hemoptysis in Colorectal Carcinoma with Multiple Lung Metastases: A Case Report

ABSTRACT A man in his 70s suffering from recurrent sigmoid colon cancer with multiple metastases was treated using tegafur/gimeracil/oteracil potassium/irinotecan (CPT-11) (16 cycles) as a first-line therapy, modified 5-FU/leucovorin/oxaliplatin as a second-line therapy and 5-FU/leucovorin/irinotecan (FOLFIRI)/bevacizumab as a third-line therapy. FOLFIRI and bevacizumab had to be discontinued after 47 cycles because of atypical pneumonia. Cetuximab/CPT-11 was used as a fourth-line regimen, but metastasis continued after two cycles. We used FOLFIRI–bevacizumab as a fifth-line therapy because a computed tomography (CT) scan did not show pneumonia, and his metastasis had been well controlled previously with this regimen. After 58 courses, CT scan showed no pneumonia, and there was no increase in lung metastases. On day 18 of 59 courses, he developed hemoptysis unexpectedly at his home, and he was brought to our hospital. On emergency CT scan, a cavity the lung field was detected in the lung field where lung metastasis had occurred, and Staphylococcus aureus was found in the patient's sputum. Intensive antibiotic therapy was initiated; however, the patient died three days later because of severe hemoptysis. Bevacizumab, a monoclonal antibody against a vascular endothelial growth factor, is used in several types of carcinoma, namely the lung, breast and colorectal cancers. In the phase trials of lung cancer, there were several reports of hemoptysis associated with bevacizumab, but there have been few reports on colorectal cancer. We reported a case of bevacizumab-associated hemoptysis in colorectal carcinoma with lung metastasis and reviewed the associated literature.