Farina Kyle, Kalac Matko, Kim Sara
The Department of Pharmacy Practice, The Mount Sinai Hospital, New York, NY, USA.
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Oncol Pharm Pract. 2021 Jun;27(4):1011-1015. doi: 10.1177/1078155220953886. Epub 2020 Sep 1.
Anthracycline-based chemotherapy regimens are associated with decreased cardiac function with cumulative dosing, yet there is limited information regarding the acute cardiotoxic potential of these medications and appropriate medical management strategies. Herein, we report a case of cardiomyopathy following a single dose of doxorubicin and describe our pharmacologic management approach.
A 37 year old Jamaican male presented for work-up and treatment of HTLV-1 associated T-cell leukemia/lymphoma. Upon diagnosis, the patient received one cycle of CHOEP, which was complicated by tumor lysis syndrome. Subsequently, the treatment was changed to DA-EPOCH, however, immediately after the initiation of DA-EPOCH on day 1, the patient was found to have t-wave inversions on EKG and an ejection fraction (EF) of 20% with new mitral regurgitation. EPOCH infusion was discontinued within 3 hours of initiation. The chemotherapy regimen was modified to DA-EPOC with the removal of doxorubicin. The patient was started on metoprolol succinate 12.5 mg once daily for 2 days and subsequently switched to carvedilol 3.125 mg twice daily and lisinopril 5 mg once daily; the patient's ejection fraction improved to baseline after 2.5 months of therapy.
Though anthracyclines are associated with cardiotoxicity at high cumulative doses, this case highlights the cardiotoxic potential of these medications in the acute setting. Management of anthracycline cardiotoxicity is similar to heart failure management, with data suggesting benefit of using carvedilol and lisinopril. It is unclear if our patient would have benefited from prophylactic angiotensin converting enzymes inhibitors (ACEi) and/or beta-blocker therapy, as he had no known cardiac disease. Acute anthracycline-induced cardiac toxicity is an adverse drug reaction with which providers should be familiar and know how to appropriately manage.
基于蒽环类药物的化疗方案与累积给药后心脏功能下降有关，但关于这些药物的急性心脏毒性潜力及适当的医学管理策略的信息有限。在此，我们报告一例单次剂量阿霉素后发生心肌病的病例，并描述我们的药物管理方法。
一名37岁的牙买加男性因进行人嗜T淋巴细胞病毒1型（HTLV-1）相关T细胞白血病/淋巴瘤的检查和治疗前来就诊。诊断后，患者接受了一个周期的CHOEP方案治疗，该治疗并发肿瘤溶解综合征。随后，治疗方案改为DA-EPOCH，但在第1天开始使用DA-EPOCH后立即发现患者心电图出现T波倒置，射血分数（EF）为20%，并出现新的二尖瓣反流。EPOCH输注在开始后3小时内停止。化疗方案改为去除阿霉素的DA-EPOC。患者开始服用琥珀酸美托洛尔12.5毫克，每日一次，共2天，随后改为卡维地洛3.125毫克，每日两次和赖诺普利5毫克，每日一次；治疗2.5个月后患者的射血分数恢复到基线水平。
虽然蒽环类药物在高累积剂量时与心脏毒性有关，但该病例突出了这些药物在急性情况下的心脏毒性潜力。蒽环类药物心脏毒性的管理与心力衰竭的管理相似，数据表明使用卡维地洛和赖诺普利有益。由于我们的患者没有已知的心脏病，尚不清楚预防性使用血管紧张素转换酶抑制剂（ACEi）和/或β受体阻滞剂治疗是否会使他受益。急性蒽环类药物诱导的心脏毒性是一种不良药物反应，医疗人员应熟悉并知道如何适当处理。
