Takahashi Naoto, Fujii Hitoshi, Iwasa Tomohiro, Koizumi Yuka, Minagawa Yukihiro, Tono Chihiro
Department of Surgery, Iwate Prefectural Kuji Hospital, Kuji, Iwate, Japan.
Case Rep Gastrointest Med. 2025 Jul 15;2025:2752788. doi: 10.1155/crgm/2752788. eCollection 2025.
Human epidermal growth factor receptor 2 (HER2)-positive gastric cancer accounts for approximately 15% of gastric cancer cases. Trastuzumab (Trz), a monoclonal antibody targeting HER2, has been shown to improve overall survival when combined with chemotherapy. However, while Trz-induced cardiotoxicity (TIC) is a well-recognized adverse effect in breast cancer chemotherapy, reports on its occurrence in gastric cancer treatment remain limited. An 80-year-old Japanese male with HER2-positive advanced gastric cancer (cStage III) developed ventricular arrhythmia and heart failure during postoperative chemotherapy with the Trz + SOX regimen (Trz, oxaliplatin, and TS-1). The patient initially underwent distal gastrectomy with D1+ lymphadenectomy for anemia and pyloric stenosis. Metastasis to the #8a lymph node (anterior superior lymph node of the common hepatic artery) and pancreatic invasion via lymph nodes were treated with two cycles of the Trz + SOX regimen, leading to a partial response. However, after the 11th cycle, he developed ventricular tachycardia and heart failure. Cardiac imaging and laboratory findings revealed no coronary artery disease or structural abnormalities, suggesting TIC as the underlying cause. Antiarrhythmic therapy with pharmacological agents led to symptom resolution, and no recurrence of arrhythmia or heart failure was observed. This case highlights the potential cardiotoxicity associated with nonanthracycline-based Trz regimens for gastric cancer. Pathophysiologically, HER2 signaling inhibition in cardiomyocytes may impair stress responses and repair mechanisms. The patient's advanced age, history of hypertension and anemia, and cumulative exposure to chemotherapy may have contributed to increased cardiac vulnerability. Careful monitoring of cardiac function is essential in elderly and comorbid patients undergoing Trz-based therapy for gastric cancer to mitigate the risk of cardiotoxicity. Trz-based chemotherapy for HER2-positive gastric cancer, even without anthracyclines, may pose a risk of cardiotoxicity, particularly in elderly or comorbid patients. Further research is warranted to elucidate underlying mechanisms and optimize monitoring and prevention strategies in this population.
人表皮生长因子受体2（HER2）阳性胃癌约占胃癌病例的15%。曲妥珠单抗（Trz）是一种靶向HER2的单克隆抗体，已证明与化疗联合使用时可提高总生存率。然而，虽然Trz诱导的心脏毒性（TIC）在乳腺癌化疗中是一种广为人知的不良反应，但关于其在胃癌治疗中发生情况的报道仍然有限。一名80岁的日本男性，患有HER2阳性晚期胃癌（cStage III），在采用Trz + SOX方案（Trz、奥沙利铂和替吉奥）进行术后化疗期间出现室性心律失常和心力衰竭。患者最初因贫血和幽门狭窄接受了远端胃切除术及D1 + 淋巴结清扫术。对第8a组淋巴结（肝总动脉前上淋巴结）转移和经淋巴结的胰腺侵犯采用了两个周期的Trz + SOX方案治疗，产生了部分缓解。然而，在第11个周期后，他出现了室性心动过速和心力衰竭。心脏成像和实验室检查结果未发现冠状动脉疾病或结构异常，提示TIC是潜在原因。使用药物进行抗心律失常治疗使症状得到缓解，且未观察到心律失常或心力衰竭复发。该病例突出了与基于非蒽环类药物的Trz方案治疗胃癌相关的潜在心脏毒性。从病理生理学角度来看，心肌细胞中HER2信号抑制可能损害应激反应和修复机制。患者的高龄、高血压和贫血病史以及化疗累积暴露可能导致心脏易损性增加。对于接受基于Trz的胃癌治疗的老年和合并症患者，仔细监测心脏功能对于降低心脏毒性风险至关重要。即使不使用蒽环类药物，基于Trz的HER2阳性胃癌化疗也可能存在心脏毒性风险，尤其是在老年或合并症患者中。有必要进行进一步研究以阐明潜在机制，并优化该人群的监测和预防策略。
