Antineoplastics
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Reactions 1245 - 28 Mar 2009 » Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of tako- ★ S Antineoplastics tsubo cardiomyopathy associated with cetuximab, folinic acid, irinotecan or oxaliplatin. The WHO ADR database Tako-tsubo cardiomyopathy (first report with contained no reports of stress cardiomyopathy (MedDRA) cetuximab, folinic acid, irinotecan and oxaliplatin) associated with cetuximab, folinic acid, irinotecan or in elderly patients: 2 case reports oxaliplatin. A 67-year-old man and a 75-year-old woman developed tako-tsubo cardiomyopathy during chemotherapy for squamous cell cancer and colon cancer, respectively [dosages not stated]. The man underwent radiotherapy and subsequently received a single dose of cetuximab. He was hospitalised with progressive lethargy 3 days later. His mental status was gradually worsening, but CSF analysis, blood work-up and CT scan were normal. He was scheduled for brain MRI, but became severely hypoxic in the MRI suite and required intubation. He then developed heart arrest and was successfully resuscitated after 10 minutes. A subsequent ECG revealed ST-segment elevation in leads V2-V6; echocardiography disclosed marked impairment of his left ventricular (LV) function with an ejection fraction of 20%, and severe distal anterior and apical hypokinesia. Cardiogenic shock necessitated high-dose inotropic support, and acute anterior ST-elevation myocardial infarction was diagnosed. Angiography showed non- obstructive coronary artery disease, and left ventriculography disclosed severe LV dysfunction and apical ballooning. He underwent placement of an intra- aortic balloon pump and was transferred to the cardiac unit. Laboratory investigations revealed a peak troponin-I level of 0.96 ng/mL. Over the next few days, his condition improved and he no longer required the balloon pump or vasopressors. He began receiving a β-blocker, an ACE inhibitor, a statin and aspirin, and was discharged 10 days after admission. His LV systolic function had improved on follow-up 2 weeks later; he had an ejection fraction of 45% and his wall motion abnormalities had resolved. The woman underwent tumour resection, and began adjuvant therapy with fluorouracil, folinic acid [leucovorin] and oxaliplatin. Her cancer later recurred and progressed despite systemic therapy with irinotecan and cetuximab; her treatment was changed to oxaliplatin and capecitabine, and she experienced acute onset of dyspnoea and abnormal ECG changes immediately after the first therapy session, 3 years after cancer diagnosis [duration of treatments to reaction onset not stated]. She was hospitalised for a suspected allergic reaction and began receiving corticosteroids. An ECG revealed new-onset deep T-wave inversion in leads V2-V6; her peak creatine phosphokinase and troponin I levels were 279 U/L and 4.23 ng/mL, respectively. Angiography disclosed non obstructive coronary artery disease. Her LV function was moderately reduced with an ejection fraction of 35–40%. Other findings included akinetic anterior and anteroapical walls, and severe hypokinesia of the inferoapical segment. She began receiving β-blockers and an ACE inhibitor, and had a normal LV function with an ejection fraction of 59% on follow-up 2 weeks later. Author comment: "This combination of cetuximab and radiation therapy could have provoked an acute cardiopulmonary event in the first patient, thus providing the trigger for the onset of takotsubo cardiomyopathy. . . Although there are no reports of cardiotoxicity of oxaliplatin, myocardial infarction has been reported with other platin-based alkylating agents, especially in conjunction with [5-fluorouracil]. Finally, direct cardiotoxic effects from these chemotherapeutic agents could have [caused] microvascular dysfunction/spasm leading to myocardial stunning in both cases." Kim L, et al. Chemotherapy-induced takotsubo cardiomyopathy. Journal of Invasive Cardiology 20: E338-E340, No. 12, Dec 2008 - USA 801132303 1 Reactions 28 Mar 2009 No. 1245 0114-9954/10/1245-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1245 - 28 Mar 2009
» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of tako-★ SAntineoplastics tsubo cardiomyopathy associated with cetuximab, folinicacid, irinotecan or oxaliplatin. The WHO ADR databaseTako-tsubo cardiomyopathy (first report withcontained no reports of stress cardiomyopathy (MedDRA)cetuximab, folinic acid, irinotecan and oxaliplatin)associated with cetuximab, folinic acid, irinotecan orin elderly patients: 2 case reports oxaliplatin.A 67-year-old man and a 75-year-old woman developed
tako-tsubo cardiomyopathy during chemotherapy forsquamous cell cancer and colon cancer, respectively[dosages not stated].
The man underwent radiotherapy and subsequentlyreceived a single dose of cetuximab. He was hospitalisedwith progressive lethargy 3 days later. His mental statuswas gradually worsening, but CSF analysis, blood work-upand CT scan were normal. He was scheduled for brain MRI,but became severely hypoxic in the MRI suite and requiredintubation. He then developed heart arrest and wassuccessfully resuscitated after 10 minutes. A subsequentECG revealed ST-segment elevation in leads V2-V6;echocardiography disclosed marked impairment of his leftventricular (LV) function with an ejection fraction of 20%,and severe distal anterior and apical hypokinesia.Cardiogenic shock necessitated high-dose inotropicsupport, and acute anterior ST-elevation myocardialinfarction was diagnosed. Angiography showed non-obstructive coronary artery disease, and leftventriculography disclosed severe LV dysfunction andapical ballooning. He underwent placement of an intra-aortic balloon pump and was transferred to the cardiacunit. Laboratory investigations revealed a peak troponin-Ilevel of 0.96 ng/mL. Over the next few days, his conditionimproved and he no longer required the balloon pump orvasopressors. He began receiving a β-blocker, an ACEinhibitor, a statin and aspirin, and was discharged 10 daysafter admission. His LV systolic function had improved onfollow-up 2 weeks later; he had an ejection fraction of 45%and his wall motion abnormalities had resolved.
The woman underwent tumour resection, and beganadjuvant therapy with fluorouracil, folinic acid [leucovorin]and oxaliplatin. Her cancer later recurred and progresseddespite systemic therapy with irinotecan and cetuximab;her treatment was changed to oxaliplatin and capecitabine,and she experienced acute onset of dyspnoea andabnormal ECG changes immediately after the first therapysession, 3 years after cancer diagnosis [duration oftreatments to reaction onset not stated]. She washospitalised for a suspected allergic reaction and beganreceiving corticosteroids. An ECG revealed new-onset deepT-wave inversion in leads V2-V6; her peak creatinephosphokinase and troponin I levels were 279 U/L and4.23 ng/mL, respectively. Angiography disclosed nonobstructive coronary artery disease. Her LV function wasmoderately reduced with an ejection fraction of 35–40%.Other findings included akinetic anterior and anteroapicalwalls, and severe hypokinesia of the inferoapical segment.She began receiving β-blockers and an ACE inhibitor, andhad a normal LV function with an ejection fraction of 59%on follow-up 2 weeks later.
Author comment: "This combination of cetuximab andradiation therapy could have provoked an acutecardiopulmonary event in the first patient, thus providing thetrigger for the onset of takotsubocardiomyopathy. . . Although there are no reports ofcardiotoxicity of oxaliplatin, myocardial infarction has beenreported with other platin-based alkylating agents, especiallyin conjunction with [5-fluorouracil]. Finally, direct cardiotoxiceffects from these chemotherapeutic agents could have[caused] microvascular dysfunction/spasm leading tomyocardial stunning in both cases."Kim L, et al. Chemotherapy-induced takotsubo cardiomyopathy. Journal ofInvasive Cardiology 20: E338-E340, No. 12, Dec 2008 - USA 801132303
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Reactions 28 Mar 2009 No. 12450114-9954/10/1245-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
