Theodotou Christian B, Shah Ashish H, Ivan Michael E, Komotar Ricardo J
Departments of aSurgery bNeurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Anticancer Drugs. 2016 Mar;27(3):259-63. doi: 10.1097/CAD.0000000000000325.
Although anticancer drugs have existed for over 50 years, targeted drugs have only recently been marketed, and their side effects may not be completely understood. The patient is a 56-year-old woman with a gastrointestinal stromal tumor who presented with headache, nausea, and vomiting lasting 2 weeks. An MRI to rule out brain metastasis found a large right-hemispheric subdural hematoma without metastases. She denied trauma, seizures, or alcohol abuse. Laboratory test results were normal. Eight months prior, she had begun a dose escalation of imatinib, which became the suspected cause of her hemorrhage. The literature was reviewed for reports of intracranial hemorrhage with targeted chemotherapeutics excluding metastases, anticoagulation, and trauma. Multiple events have been documented but only one for imatinib with gastrointestinal stromal tumor. Imatinib is believed to cause platelet dysfunction (missed by standard testing), leading to intracranial hemorrhage. Intracranial hemorrhage risk may be under-reported and neurosurgical consultation for immediate treatment and oncology for reinitiation of chemotherapy are recommended.
尽管抗癌药物已经存在了50多年，但靶向药物直到最近才上市，其副作用可能尚未完全明了。患者为一名56岁女性，患有胃肠道间质瘤，出现头痛、恶心和呕吐症状达2周。为排除脑转移进行的MRI检查发现右侧大脑半球有一个巨大的硬膜下血肿，无转移灶。她否认有外伤、癫痫发作或酗酒史。实验室检查结果正常。8个月前，她开始增加伊马替尼的剂量，这被怀疑是她出血的原因。查阅了相关文献，以了解排除转移、抗凝和外伤因素后，靶向化疗药物导致颅内出血的报告。已有多起此类事件记录在案，但伊马替尼导致胃肠道间质瘤患者颅内出血的仅有一例。据信伊马替尼会导致血小板功能障碍（标准检测无法发现），进而导致颅内出血。颅内出血的风险可能未得到充分报道，建议立即进行神经外科会诊以进行治疗，并建议肿瘤科重新启动化疗。
