Cardiovascular Toxicity of Bevacizumab in Long-term Survival of Recurrent Ovarian Cancer: A Case Report

Abstract

Introduction: Bevacizumab has been shown to improve progression-free survival in women with ovarian cancer in multiple clinical trials. Cardiovascular toxicity is reported in the case of a long term survivor of recurrent ovarian cancer. Case Report: A 47-year-old woman was diagnosed as stage IIIC, Grade 3 endomitriod adenocarcinoma of the ovary. She had been treated with 4 debulking surgeries and 6 different chemotherapy regimens for 9 years. However, remission diminished over this time period to only one month. Bevacizumab was administrated with additional chemotherapies, and prolonged survival was demonstrated over the next 5 years, including ongoing remission of 18 months to date. New onset hypertension was developed at the 10 th month of bevacizumab treatment, and proteinuria was found at the 12 th month. Patient presented symptoms of coronary artery disease during the 31 th month of bevacizumab treatment, and was soon treated with 4 stents, whereby symptoms resolved. After the 36 th month of bevacizumab, the patient had non ST elevated myocardial infarction and peripheral vascular disease. Bevacizumab was terminated thereafter. In the following 18 months, the patient was treated with angioplasty 2 times for coronary artery occlusion, and with an additional stent. This was followed with coronary artery bypass graft. She also had an angioplasty for right femoral artery stenosis. Throughout most of the 14 year disease course, the patient maintained a good quality of life. As patients achieve long term survival from bevacizumab treatment, cardiovascular complications should be recognized and treated aggressively to minimize the adverse effects of cancer therapy.