Tufts University School of Medicine, Tufts Cancer Center, Boston, MA, U.S.A.
Anticancer Res. 2014 Dec;34(12):7267-70.
Gemcitabine plus nab-paclitaxel is a novel combination chemotherapy that is currently being used in patients with metastatic pancreatic cancer. Phase III trials have shown improved survival, response rates, and disease-free progression. The most significant side-effects include peripheral neuropathy and myelotoxicity. Review of literature has shown rare cases of congestive heart failure associated with gemcitabine plus nab-paclitaxel. We describe two cases of women who were treated with gemcitabine plus nab-paclitaxel for pancreatic adenocarcinoma who developed acute exacerbation of congestive heart failure.
Two women with pancreatic adenocarcinoma were both treated with gemcitabine plus nab-paclitaxel and developed acute decompensated heart failure requiring hospitalization and standard treatment for heart failure including i.v. diuretics. Once chemotherapy was discontinued, symptoms resolved.
Based on review of literature, as far as we are aware of, this is the first report of congestive heart failure as an adverse effect of combination therapy. Both patients had evidence of diastolic dysfunction which may have predisposed them to cardiac toxicity secondary to gemcitabine plus nab-paclitaxel. The exact mechanism of action is currently unknown and requires further studies. However, it is imperative for physicians to be aware of this adverse effect and closely monitor patients with underlying heart disease who are undergoing treatment with gemcitabine plus nab-paclitaxel.
吉西他滨联合 nab-紫杉醇是一种新型的联合化疗药物，目前正在转移性胰腺癌患者中使用。III 期临床试验表明，该联合方案提高了患者的生存率、缓解率和无疾病进展期。最显著的副作用包括周围神经病变和骨髓抑制。文献回顾显示，吉西他滨联合 nab-紫杉醇与心力衰竭相关的罕见病例。我们描述了两例接受吉西他滨联合 nab-紫杉醇治疗胰腺腺癌的女性患者，她们均出现心力衰竭急性加重。
两名患有胰腺腺癌的女性均接受吉西他滨联合 nab-紫杉醇治疗，出现急性失代偿性心力衰竭，需要住院并接受心力衰竭的标准治疗，包括静脉利尿剂。一旦停止化疗，症状就会缓解。
根据文献回顾，据我们所知，这是首例报告吉西他滨联合 nab-紫杉醇治疗引起心力衰竭的不良反应。两名患者均有舒张功能障碍的证据，这可能使她们容易发生继发于吉西他滨联合 nab-紫杉醇的心脏毒性。确切的作用机制目前尚不清楚，需要进一步研究。然而，医生必须意识到这种不良反应，并密切监测正在接受吉西他滨联合 nab-紫杉醇治疗的有潜在心脏病的患者。
