Vita-Salute San Raffaele University, Milan, Italy.
Disease Unit for Myocarditis & Arrhythmogenic Cardiomyopathies, IRCCS San Raffaele Hospital, Milan, Italy.
Cardiovasc Toxicol. 2024 Nov;24(11):1168-1173. doi: 10.1007/s12012-024-09906-w. Epub 2024 Jul 31.
Cardiac toxicity is an adverse event of several classes of anti-cancer drugs. Herein, we present the case of a 52-year-old woman with metastatic renal cell carcinoma (RCC), previously treated with debulking surgery, pembrolizumab (immune checkpoint inhibitor) in combination with axitinib (tyrosine kinase inhibitor (TKI)), followed by lenvatinib (TKI) and belzutifan (HIF-2α inhibitor), who developed myocarditis proven by cardiac magnetic resonance and endomyocardial biopsy. The case was notable for reporting a not-yet described adverse event during treatment with belzutifan plus lenvatinib, the etiology of which was of unobvious determination given the pre-exposure to pembrolizumab, a known cause of drug-related myocarditis. We surmise that myocarditis was a delayed adverse event related to pembrolizumab (8 months after treatment interruption), although we emphasize that only attentive monitoring of cardiac adverse events of patients exposed to belzutifan and lenvatinib in the context of large clinical trials may rule out any causal implication of these drugs.
心脏毒性是几类抗癌药物的不良反应。在此，我们报告了一例 52 岁女性转移性肾细胞癌（RCC）患者的病例，该患者既往接受过减瘤手术、帕博利珠单抗（免疫检查点抑制剂）联合阿昔替尼（酪氨酸激酶抑制剂（TKI））、仑伐替尼（TKI）和贝伐珠单抗（HIF-2α抑制剂）治疗，随后因心肌炎而进行了心脏磁共振和心内膜心肌活检。该病例的特点是报告了在接受贝伐珠单抗联合仑伐替尼治疗期间发生的一种尚未描述的不良事件，由于在接受已知可引起药物相关性心肌炎的帕博利珠单抗治疗前就已接触过该药，因此病因难以确定。我们推测心肌炎是与帕博利珠单抗相关的迟发性不良事件（治疗中断后 8 个月），尽管我们强调，只有在大型临床试验中密切监测暴露于贝伐珠单抗和仑伐替尼的患者的心脏不良事件，才能排除这些药物的任何因果关系。
