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恩曲替尼诱发的 Brugada 综合征所致致命性室性心律失常:一例报告及文献综述

Lethal ventricular arrhythmia due to entrectinib-induced Brugada syndrome: a case report and literature review.

作者信息

Futamura Keisuke, Hase Tetsunari, Tanaka Akihito, Sakai Yoshinori, Okachi Shotaro, Shibata Hirofumi, Ushijima Futoshi, Hashimoto Takahiko, Nakashima Kuniya, Ito Katsuki, Yamamoto Takanori, Numaguchi Atsushi, Inden Yasuya, Ishii Makoto

机构信息

Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, 466-8550 Japan.

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Int Cancer Conf J. 2023 Jun 26;12(4):299-304. doi: 10.1007/s13691-023-00620-y. eCollection 2023 Oct.

Abstract

Entrectinib, a multikinase inhibitor of and tropomyosin receptor kinases, is recommended to treat -positive metastatic non-small cell lung cancer (NSCLC). In a previous study, entrectinib-related cardiotoxicity occurred in 2% of patients; however, lethal arrhythmias remain understudied. We encountered a case of fatal arrhythmia due to drug-induced Brugada syndrome caused by entrectinib. An 81-year-old Japanese male with lung adenocarcinoma harboring -fusion gene was treated with entrectinib. The patient developed lethal arrhythmias three days after drug initiation, including ventricular tachycardia with Brugada-like electrocardiogram changes. Echocardiography and coronary angiography revealed no evidence of acute coronary syndrome or myocarditis. Following the termination of entrectinib, the electrocardiogram abnormality improved within 12 days. Hence, paying special attention to and monitoring electrocardiogram changes is necessary. In addition, it is also necessary to consider early therapeutic interventions and discontinuation of the drug in cases of drug-induced Brugada syndrome.

摘要

恩曲替尼是一种酪氨酸激酶和原肌球蛋白受体激酶的多激酶抑制剂,被推荐用于治疗NTRK阳性转移性非小细胞肺癌(NSCLC)。在先前的一项研究中,2%的患者出现了与恩曲替尼相关的心脏毒性;然而,致命性心律失常仍未得到充分研究。我们遇到了一例因恩曲替尼引起的药物性 Brugada 综合征导致的致命性心律失常病例。一名81岁携带NTRK融合基因的日本男性肺腺癌患者接受了恩曲替尼治疗。患者在开始用药三天后出现致命性心律失常,包括伴有类似Brugada心电图改变的室性心动过速。超声心动图和冠状动脉造影未发现急性冠状动脉综合征或心肌炎的证据。停用恩曲替尼后,心电图异常在12天内得到改善。因此,有必要特别关注并监测心电图变化。此外,对于药物性Brugada综合征病例,还需要考虑早期治疗干预和停药。

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