Esophageal ulcer in a patient who received bevacizumab

A 60-year-old woman with metastatic rectal cancer who after surgical resection of the primary and creation of a palliative ileostomy in May 2006, was started on a regimen of bevacizumab, irinotecan, 5-fluouracil and leucovorin. After 3 cycles, she presented with solid food dysphagia. An endoscopy showed a large, deep ulcer in the lower third of the esophagus. We assumed that it was related to bevacizumab treatment. Bevacizumab was stopped and she was started on pantoprazole. Over the ensuing months, the ulcer improved notably. To the best of our knowledge, an esophageal ulcer associated with bevacizumab treatment has not been reported. This is likely the precursor lesion to a gastrointestinal tract perforation.