一名患有结肠癌和远处转移的75岁女性接受了氟尿嘧啶治疗,左亚叶酸,术后伊立替康(FOLFIRI)加贝伐单抗。在第32期课程中,患者出现大量蛋白尿,仅停用贝伐单抗;蛋白尿随时间迅速改善.然而,6个多月后,患者再次出现大量蛋白尿,肾功能下降.肾活检显示肾小球微血管病伴明显的泡沫细胞浸润肾小球,这被认为是由肾小球毛细血管的慢性内皮细胞损伤引起的。内皮细胞损伤被认为不仅由贝伐单抗在肾小球毛细血管中的血管内皮生长因子作用的抑制引起,而且由伴随的抗癌药物的细胞毒性和共存的临床病症如血脂异常和高血压引起。在停止抗癌药并加强饮食和降压治疗后,蛋白尿和血脂异常缓慢改善;然而,很难继续进行足够的化疗,肿瘤标志物水平恶化。联合疗法,包括分子靶向药物,已经变得常见,预计抗癌剂的副作用将继续复杂。为了防止肾脏并发症的发生和严重程度,血压管理,血脂水平,和葡萄糖代谢,以及多学科医疗管理,包括饮食疗法,是必需的。
A 75-year-old woman with colon cancer and distant metastases was treated with fluorouracil, levofolinate, and irinotecan (FOLFIRI) plus bevacizumab postoperatively. During the 32nd course, the patient developed massive proteinuria, and only bevacizumab was discontinued; the proteinuria improved rapidly over time. However, more than six months later, the patient developed massive proteinuria again, and her renal function declined. Renal biopsy revealed glomerular microangiopathy with prominent foam cell infiltration into the glomerulus, which was thought to be caused by chronic endothelial cell damage to the glomerular capillaries. Endothelial cell damage is thought to be caused not only by the inhibition of vascular endothelial growth factor action of bevacizumab in the glomerular capillary but also by the cytotoxicity of the concomitant anticancer drugs and coexisting clinical conditions such as dyslipidemia and hypertension. After discontinuing anticancer agents and intensifying diet and antihypertensive therapy, proteinuria and dyslipidemia slowly improved; however, it became difficult to continue adequate chemotherapy, and the tumor marker levels worsened. Combination therapies, including molecular targeted agents, have become common, and the side effects of anticancer agents are expected to continue to be complicated. To prevent the onset and severity of renal complications, management of blood pressure, lipid level, and glucose metabolism, as well as multidisciplinary medical management, including dietary therapy, is required.