Summary
Chemotherapy-related cardiac toxicity is a rare but serious adverse event in patients with cancer. Thus far, no case of serious cardiac toxicity of pemetrexed has been reported. We describe the case of a patient with advanced lung cancer and cardiomyopathy due to pemetrexed. A 59-year-old woman visited our hospital, and we found abnormal findings on a chest radiograph. She was diagnosed as having stage IV lung adenocarcinoma. Chemotherapy with cisplatin and pemetrexed every 3 weeks was initiated. After four cycles of chemotherapy, maintenance chemotherapy with pemetrexed was administered every 3 weeks. During the seventeenth cycle of pemetrexed, she had shortness of breath in her daily life. A chest radiograph showed an enlarged cardiothoracic ratio (66%), and the transthoracic echocardiogram demonstrated expansion of the left ventricle (diastolic diameter, 67 mm), severe global hypokinesis, and reduced left ventricular ejection fraction (28%). The coronary angiogram showed no coronary constriction. There was no delayed accumulation on the contrast-enhanced cardiac magnetic resonance imaging scan. After right heart catheterization, pathological results of a myocardial biopsy from the ventricular septum indicated no cardiac muscle hypertrophy, cardiac fibrosis, inflammatory cell infiltration, or myocyte disarray. Eventually, she was diagnosed as having pemetrexed-induced cardiomyopathy. Pemetrexed was discontinued, and furosemide, enalapril, and carvedilol were started. Then her symptoms and cardiac function improved. Early detection and discontinuation of causative agents are the most important treatment strategies in similar patients. Diuretics, angiotensin-conversion enzyme inhibitors, and beta-blockers may be effective for treating heart failure.
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References
Floyd JD, Nguyen DT, Lobins RL et al (2005) Cardiotoxicity of cancer therapy. J Clin Oncol 23:7685–7696
Zamorano JL, Lancellotti P, Rodriguez Muñoz D et al (2016) 2016 ESC position paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for practice guidelines: the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J 37:2768–2801
Yeh ET, Bickford CL (2009) Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol 53:2231–2247
Hanna N, Shepherd FA, Fossella FV et al (2004) Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol 22:1589–1597
Rusthoven JJ, Eisenhauer E, Butts C et al (1999) Multitargeted antifolate LY231514 as first-line chemotherapy for patients with advanced non-small-cell lung cancer: a phase II study. National Cancer Institute of Canada Clinical Trials Group, J Clin Oncol 17:1194–1199
Kajihara H, Yokozaki H, Yamahara M et al (1986) Anthracycline induced myocardial damage. An analysis of 16 autopsy cases. Pathol Res Pract 181:434–441
Perez-Verdia A, Angulo F, Hardwicke FL et al (2005) Acute cardiac toxicity associated with high-dose intravenous methotrexate therapy: case report and review of the literature. Pharmacotherapy 25:1271–1276
Welch GN, Loscalzo J (1998) Homocysteine and atherothrombosis. N Engl J Med 338:1042–1050
Ewer MS, Lippman SM (2005) Type II chemotherapy-related cardiac dysfunction: time to recognize a new entity. J Clin Oncol 23:2900–2902
Moudgil R, Haddad H (2017) Chemotherapy-related cardiac dysfunction: grey area in type I and type II classification. Curr Opin Cardiol 32:181–188
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Takuya Oyakawa reports personal fees from Bristol-Myers Squibb, personal fees from Sumitomo Dainippon Pharma, personal fees from Pfizer. Kei Iida reports personal fees from Ono Pharmaceutical Co, Ltd., personal fees from Bristol-Myers, personal fees from Daiichi Sankyo, personal fees from Toa eiyo Ltd. Hirotsugu Kenmotsu reports grants and personal fees from AstraZeneca K.K., grants and personal fees from Chugai Pharmaceutical Co, Ltd., personal fees from Ono Pharmaceutical Co, Ltd., personal fees from Bristol-Myers K.K, grants and personal fees from Boeringer Ingelheim, personal fees from Eli Lilly K.K, personal fees from Kyowa Hakko Kirin Co., Ltd. Masatoshi Kusuhara has nothing to disclose. Takashi Sugino has nothing to disclose.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Oyakawa, T., Iida, K., Kusuhara, M. et al. Chemotherapy-induced cardiomyopathy caused by Pemetrexed. Invest New Drugs 36, 147–150 (2018). https://doi.org/10.1007/s10637-017-0485-5
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DOI: https://doi.org/10.1007/s10637-017-0485-5