Ribeiro K B, Miranda C H, Andrade J M, Galli L G, Tiezzi D G, Oliveira H F, Zola F E, Volpe G, Pazin-Filho A, Peria F M
Clinical Oncology Division, University of São Paulo - FMRP-USP, São Paulo, Brazil.
Case Rep Oncol. 2012 Jan;5(1):125-33. doi: 10.1159/000337576. Epub 2012 Mar 17.
Trastuzumab is an important biological agent in the treatment of HER2-positive breast cancer, with effects on response rates, progression-free survival, overall survival and quality of life. Although this drug is well tolerated in terms of adverse effects, trastuzumab-associated myocardiotoxicity has been described to have an incidence of 0.6-4.5% and in rare cases, the drug can trigger severe congestive heart failure with progression to death or even mimic acute coronary syndrome with complete left bundle branch blockade. In this paper is reported a case of trastuzumab-associated myocardiotoxicity manifesting as acute coronary syndrome in a 69-year-old female. The patient is currently undergoing a conservative clinical treatment that restricts overexertion.The majority of clinical studies report trastuzumab-induced cardiotoxicity as a rare event, and, when present, characterized by mild to moderate clinical signs, the ease of reversibility with pharmacological measures and the temporary discontinuation of the medication. Conversely, it is vital for the oncologist/cardiologist to consider the possibility that trastuzumab-induced cardiotoxicity may manifest itself as a severe clinical case, mimicking acute coronary syndrome, justifying careful risk stratification and adequate cardiac monitoring, especially in high-risk patients.
曲妥珠单抗是治疗HER2阳性乳腺癌的一种重要生物制剂，对缓解率、无进展生存期、总生存期和生活质量均有影响。尽管该药物在不良反应方面耐受性良好，但据报道曲妥珠单抗相关的心肌毒性发生率为0.6 - 4.5%，在极少数情况下，该药物可引发严重的充血性心力衰竭并进展至死亡，甚至可模拟伴有完全性左束支传导阻滞的急性冠状动脉综合征。本文报道了一例69岁女性患者，曲妥珠单抗相关的心肌毒性表现为急性冠状动脉综合征。该患者目前正在接受限制过度劳累的保守临床治疗。大多数临床研究报告曲妥珠单抗诱导的心脏毒性为罕见事件，且一旦出现，其临床体征为轻至中度，易于通过药物措施逆转且停药后症状可暂时缓解。相反，肿瘤学家/心脏病学家必须考虑到曲妥珠单抗诱导的心脏毒性可能表现为严重临床病例，模拟急性冠状动脉综合征，这使得仔细的风险分层和充分的心脏监测至关重要，尤其是在高危患者中。
