Qiao Zhen, Li LiuDan, Wang Hong, Dai ShuHui, Ye LiTong
Department of Breast Surgery, Zhuhai Center For Maternal and Child Health Care (Zhuhai Women and Children's Hospital), Zhuhai, China.
Department of Nursing, Zhuhai Center For Maternal and Child Health Care (Zhuhai Women and Children's Hospital), Zhuhai, China.
Thorac Cancer. 2025 Sep;16(18):e70168. doi: 10.1111/1759-7714.70168.
Trastuzumab deruxtecan (T-DXd) significantly improves outcomes in HER2-positive or low metastatic breast cancer (MBC), but systematic documentation of its myotoxicity is lacking. A 45-year-old woman with HER2-low MBC and normal body composition (BMI 22.9 kg/m, visceral adipose area [VAT] 69.1 cm) developed T-DXd myopathy. She experienced dysphagia, Grade III myalgia, and creatine kinase (CK) peak of 1755 U/L, with MRI confirming lumbar subcutaneous edema and paraspinal muscle swelling. T-DXd was discontinued. Supportive therapy included hydration, urine alkalization by sodium bicarbonate, glutathione, and magnesium isoglycyrrhizinate. By Day 8, CK decreased to 539 U/L with myalgia improvement. After 13 days off therapy, CK rebounded to 1735 U/L with Grade III myalgia, which resolved upon reinitiating support. This case report presents the first documented instance of severe T-DXd-related myopathy in a patient with normal body composition. The observed case outcomes suggest that the combination of glutathione and magnesium isoglycyrrhizinate could potentially reduce CK levels and alleviate T-DXd-associated muscle pain. However, the observed clinical efficacy is based on an individual case. Extrapolation of these clinical outcomes requires large-scale randomized controlled trials with rigorous covariate adjustment.
曲妥珠单抗德鲁昔单抗（T-DXd）可显著改善HER2阳性或低表达转移性乳腺癌（MBC）的预后，但缺乏关于其肌毒性的系统性记录。一名45岁的HER2低表达MBC女性患者，身体成分正常（BMI 22.9kg/m²，内脏脂肪面积[VAT] 69.1cm²），发生了T-DXd相关性肌病。她出现吞咽困难、III级肌痛，肌酸激酶（CK）峰值达1755U/L，MRI证实腰部皮下水肿和椎旁肌肉肿胀。停用T-DXd。支持性治疗包括补液、用碳酸氢钠碱化尿液、使用谷胱甘肽和异甘草酸镁。到第8天，CK降至539U/L，肌痛改善。停药13天后，CK反弹至1735U/L，出现III级肌痛，再次开始支持性治疗后症状缓解。本病例报告展示了首例身体成分正常的患者发生严重T-DXd相关性肌病的记录实例。观察到的病例结果表明，谷胱甘肽和异甘草酸镁联合使用可能会降低CK水平并减轻T-DXd相关的肌肉疼痛。然而，观察到的临床疗效基于单个病例。要推断这些临床结果，需要进行大规模随机对照试验并进行严格的协变量调整。
