Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical School, Minneapolis, Minnesota, USA
Oncologist. 2019 Jul;24(7):e600-e602. doi: 10.1634/theoncologist.2018-0891. Epub 2019 Apr 10.
Tyrosine kinase inhibitors (TKIs) can cause cardiotoxicity, and some suggest routine monitoring of cardiac function during TKI use. We describe two cases of TKI-induced heart failure (HF) that suggest the utility of monitoring with laboratory tests is questionable. One patient developed HF 5 days after starting pazopanib. The other developed HF while receiving 25 mg per day sunitinib, and had previously received a higher dose (50 mg per day) with no symptoms of cardiotoxicy. In addition, she later received 5 cycles of sunitinib (25 mg per day) without developing an abnormal left ventricular ejection fraction (LVEF) value by echocardiography or cardiac symptoms. Although the LVEF is commonly performed to monitor TKI cardiotoxicity, evidence for its predictive utility is limited. These cases raise questions regarding the practical utility of sequential measurement of LVEF in adults treated with TKIs. We suggest a simple daily activity such as stair climbing to monitor exercise tolerance.
酪氨酸激酶抑制剂 (TKIs) 可引起心脏毒性，一些人建议在使用 TKI 期间常规监测心脏功能。我们描述了两例 TKI 引起的心力衰竭 (HF) 病例，这表明实验室检测监测的效用值得怀疑。一名患者在开始使用帕唑帕尼后 5 天出现 HF。另一名患者在接受每天 25 毫克舒尼替尼治疗时出现 HF，此前曾接受更高剂量（每天 50 毫克）治疗，没有心脏毒性症状。此外，她后来接受了 5 个周期的舒尼替尼（每天 25 毫克）治疗，心脏超声和心脏症状均未出现左心室射血分数 (LVEF) 值异常。尽管 LVEF 常用于监测 TKI 心脏毒性，但关于其预测效用的证据有限。这些病例引发了关于在接受 TKI 治疗的成年人中连续测量 LVEF 的实际效用的问题。我们建议进行日常活动，如爬楼梯，以监测运动耐量。
