Prolonged Bradycardia Induced by Bevacizumab-Associated Infusion Reaction in Advanced Metastatic Colon Cancer

Abstract

A 71-year-old man complaining of bilateral leg edema and general fatigue was admitted to the hospital and diagnosed as advanced sigmoid colon cancer with multiple liver and lung metastasis. The 5-FU/leucovorin/oxaliplatin (FOLFOX)/bevacizumab was started as a first-line therapy. In the second course of FOLFOX/bevacizumab, just after finishing infusion of bevacizumab, he felt severe thrill with chill and got fever (maximum of 38.1 C). Since the symptom was diagnosed as an infusion reaction induced by bevacizumab, treatment with steroid and histamine antagonist was performed. His symptom disappeared soon after the treatment; however, his heart rate came lower below 50/minute 5 hours after the infusion reaction (his heart rate was routinely around 60/minute). The 12-lead electrocardiogram showed sinus bradycardia. The bradycardia (30 - 49/minute) continues at least 60 hours and spontaneously recovered. Literature search of PubMed showed just two papers implying the relation between bevacizumab and bradycardia. This case suggested that bradycardia induced by bevacizumab-associated infusion reaction should be carefully followed up and might be observed with admission if necessary.




J Med Cases. 2015;6(5):194-197
doi: https://doi.org/10.14740/jmc2066w