Abdulfattah Ammar Y, Tajuddin Salman, Akkari Nada, Elsayed Omar I, Graham-Hill Suzette
Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA.
Internal Medicine, LewisGale Medical Center, Salem, USA.
Cureus. 2024 May 14;16(5):e60298. doi: 10.7759/cureus.60298. eCollection 2024 May.
Bicalutamide, a nonsteroidal androgen receptor inhibitor, is an established therapeutic agent for advanced prostate cancer but is associated with severe cardiovascular side effects in rare cases. This case report discusses a rare occurrence of severe systolic congestive heart failure (CHF) in a 68-year-old male undergoing treatment for advanced prostate cancer with bicalutamide, without concurrent use of gonadotropin-releasing hormone antagonists. The patient presented with non-specific abdominal and bilateral foot pain. The initial assessment indicated anemia and severe dyspnea, revealing a significant decrease in left ventricular ejection fraction (LVEF) from 55% to 15% on transthoracic echocardiography (TTE), indicative of severe CHF. Bicalutamide was identified as the likely culprit given the temporal association and lack of other identifiable causes, leading to its discontinuation and initiation of guideline-directed medical therapy (GDMT). A remarkable recovery of cardiac function was subsequently observed, with LVEF improving to 60%. The patient was managed with GDMT, and a gonadotropin-releasing hormone antagonist, degarelix, was later introduced for prostate cancer treatment, along with ongoing cardiac monitoring. The recovery of LVEF and the absence of other etiologies reinforce the likelihood of bicalutamide-induced cardiotoxicity. This report underscores the importance of vigilant cardiovascular monitoring in patients receiving bicalutamide, prompt identification of cardiac dysfunction and possible mechanisms of bicalutamide cardiotoxicity, and the potential for cardiac recovery upon drug discontinuation and initiation of GDMT.
比卡鲁胺是一种非甾体类雄激素受体抑制剂，是治疗晚期前列腺癌的常用药物，但在罕见情况下会伴有严重的心血管副作用。本病例报告讨论了一名68岁男性在接受比卡鲁胺治疗晚期前列腺癌时罕见地出现严重收缩性充血性心力衰竭（CHF）的情况，该患者未同时使用促性腺激素释放激素拮抗剂。患者表现为非特异性腹痛和双侧足部疼痛。初步评估显示贫血和严重呼吸困难，经胸超声心动图（TTE）显示左心室射血分数（LVEF）从55%显著降至15%，提示严重CHF。鉴于时间关联且缺乏其他可识别的病因，比卡鲁胺被确定为可能的罪魁祸首，导致停用比卡鲁胺并开始进行指南指导的药物治疗（GDMT）。随后观察到心脏功能显著恢复，LVEF提高到60%。患者接受GDMT治疗，后来引入促性腺激素释放激素拮抗剂地加瑞克用于前列腺癌治疗，并持续进行心脏监测。LVEF的恢复以及不存在其他病因强化了比卡鲁胺引起心脏毒性的可能性。本报告强调了在接受比卡鲁胺治疗的患者中进行警惕的心血管监测、及时识别心脏功能障碍以及比卡鲁胺心脏毒性可能机制的重要性，以及停药并开始GDMT后心脏恢复的可能性。
