毒性探戈:TKI和TCI心脏毒性。

IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Juan Del Cid Fratti, Vijayasree Paleru, Madhuri Bajaj, Chetan Bhardwaj
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引用次数: 0

摘要

背景:免疫检查点抑制剂(ICI)和酪氨酸激酶抑制剂(TKI)对几种类型的癌症有效,但它们可能有一些心脏毒性副作用。我们报告了一例TKI-ICI毒性导致多器官炎症综合征合并心肌炎和血栓性STEMI,并成功地通过大剂量类固醇和PCI治疗。病例介绍:72岁男性患者,每3周服用派姆单抗200mg IV,过去5个月服用阿西替尼5mg PO q12h,主讲急性呼吸短促,精神状态改变,慢性腹泻。冠状动脉造影显示右冠状动脉(RCA)血栓形成病变,经皮冠状动脉介入治疗(PCI)成功。尽管行PCI治疗,患者仍抱怨呼吸急促,进一步的心脏MRI (CMR)检查显示射血分数为38%,心包积液少,下壁延迟钆增强(DGE)提示心肌炎。大剂量类固醇的经验性试验改善了所有患者的症状和射血分数;因此,改变了化疗方案。结论:本病例报告强调了阿西替尼和派姆单抗免疫相关性心肌炎的潜在血管生成作用。心脏病专家和肿瘤学家应该警惕阿西替尼和派姆单抗的心脏毒性作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The toxic tango: TKI and TCI cardiotoxicities.

Background: Immune checkpoint inhibitors (ICI) and Tyrosine kinase inhibitors (TKI) are effective for several types of cancers, but they can have several cardiotoxicity sides effects. We present a case of TKI-ICI toxicity resulting in multiorgan inflammatory syndrome with myocarditis and thrombotic STEMI that were successfully treated with high-dose steroids and PCI.

Case presentation: Seventy-two year-old man patient treated with on pembrolizumab 200 mg IV every 3 weeks and Axitinib 5 mg PO q12h for the past 5 months complained of acute shortness of breath, altered mental status, and chronic diarrhea. Coronary angiography demonstrated a thrombotic lesion in the right coronary artery (RCA) that was treated successfully with percutaneous coronary intervention (PCI). Despite PCI he continued to complain of shortness of breath further workup with Cardiac MRI (CMR) was obtained showed an ejection fraction of 38%, small pericardial effusion, and delayed gadolinium enhancement (DGE) in the inferior wall suggestive of myocarditis. An empirical trial of high-dose steroids improved all patient symptoms and ejection fraction; therefore, the chemotherapy regimen was changed.

Conclusion: This case report highlights the potential vasculogenic effects of Axitinib and immune-related myocarditis of pembrolizumab. Cardiologists and oncologists should be vigilant for the cardiotoxic effects of Axitinib and pembrolizumab.

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来源期刊
Cardio-oncology
Cardio-oncology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
5.00
自引率
3.00%
发文量
17
审稿时长
7 weeks
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