A case of Pazopanib-related colon ischemia with perforation

We report a 40-year-old man who was diagnosed with myxoid liposarcoma of left thigh in 2012. Patient received adjuvant chemotherapy and radiation following postoperative tumor control; however, the disease continued to progress. Pazopanib was administered. Eight months later, patient experienced hollow organ perforation with septic shock, so emergency exploratory laparotomy was performed. During the operation, a 10-cm linear ulcer with a 0.2 × 0.1 cm perforation hole over the middle sigmoid colon was observed. Segmental colonic congestion with ischemic change was noted.Pazopanib is an oral small-molecule multi-kinase inhibitor. According to the results of a phase III clinical trial of pazopanib in patients with soft tissue sarcoma, some uncommon adverse effects were described in the study, but bowel perforation was not noted. However, pazopanib is also used for renal cell carcinoma with metastasis. This indication of a phase III clinical trial has listed gastrointestinal (GI) perforation or fistula as an adverse effect. Considering the complication of colon ischemia, similar to that with other vascular endothelial growth factor receptor (VEGFR) inhibitors, we emphasize the risk of colon perforation under long-term use of pazopanib.