Chino Haruka, Amano Yosuke, Yamauchi Yasuhiro, Matsuda Jun, Takeda Norihiko, Tanaka Goh, Takai Daiya, Nagase Takahide
Department of Respiratory Medicine, the University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
Department of Cardiovascular Medicine, the University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
J Thorac Dis. 2016 Sep;8(9):2646-2650. doi: 10.21037/jtd.2016.08.96.
We report the case of a 55-year-old man with stage IV lung adenocarcinoma who received carboplatin-paclitaxel-bevacizumab chemotherapy as second-line therapy. After four cycles of chemotherapy, he experienced syncope with a decrease in blood pressure. Electrocardiography (ECG) revealed atrial fibrillation. Cardiac ultrasonography showed a markedly reduced ejection fraction (45%), with moderate decrease in comparison to that before chemotherapy (66%). Bisoprolol fumarate was initiated, and the conversion to sinus rhythm was detected by ECG 4 days after the syncope. At that time, no improvement in the ejection fraction was detected. Bevacizumab-associated cardiotoxicity was suspected, and bevacizumab maintenance therapy was discontinued, although the chemotherapy achieved a stable disease status based on the Response Evaluation Criteria in Solid Tumors. Two months after bevacizumab cessation, the ejection fraction improved to pretreatment level (62%). To the best of our knowledge, this is the first report on cardiogenic syncope due to left ventricular dysfunction that is most consistent with bevacizumab-associated cardiotoxicity in non-small cell lung cancer (NSCLC). Our results indicate that bevacizumab could lead to cardiotoxicity in patients with NSCLC and suggest the importance of the follow-up cardiac ultrasonography.
我们报告了一例55岁的IV期肺腺癌男性患者，其接受卡铂-紫杉醇-贝伐单抗化疗作为二线治疗。四个周期的化疗后，他出现晕厥且血压下降。心电图（ECG）显示房颤。心脏超声检查显示射血分数显著降低（45%），与化疗前相比中度下降（66%）。开始使用富马酸比索洛尔，晕厥后4天通过心电图检测到转为窦性心律。此时，未检测到射血分数改善。怀疑与贝伐单抗相关的心脏毒性，尽管根据实体瘤疗效评价标准化疗达到疾病稳定状态，但仍停用贝伐单抗维持治疗。停用贝伐单抗两个月后，射血分数改善至治疗前水平（62%）。据我们所知，这是关于非小细胞肺癌（NSCLC）中因左心室功能障碍导致的心源性晕厥的首次报告，这种情况与贝伐单抗相关的心脏毒性最为相符。我们的结果表明，贝伐单抗可能导致NSCLC患者发生心脏毒性，并提示心脏超声随访的重要性。
