内容紹介
A Case of Breast Cancer with Repeated Cardiac Dysfunction due to Trastuzumab
Summary
Here we present a case of breast cancer in which cardiac dysfunction had previously been observed on trastuzumab(TRS)administration; the condition then improved but reoccurred on readministration of TRS. A 52-year-old woman received preoperative chemotherapy for StageⅢC left breast cancer(fluorouracil, epirubicin and cyclophosphamide followed by docetaxel and TRS), and then underwent partial mastectomy and axillary lymph node dissection. For adjuvant therapy, she received endocrine therapy and TRS. Radiation therapy was administered to the left residual breast. The patient complained about palpitation in the 5th cycle of TRS, and left ventricle ejection fraction(LVEF)decreased to 45.3% from 64%. Therefore, we stopped TRS administration. Palpitation improved, and LVEF increased to 53% after 2 months. TRS was administered again; however, palpitation reoccurred and LVEF decreased to 44%. TRS administration was once again discontinued. However, according to the HERA trial report regarding patients with a history of anthracycline and radiation therapy, TRS administration could be resumed when LVEF is greater than 50%, but we should be more careful during readministration of TRS.
要旨
trastuzumab(TRS)によって心機能が低下し,改善後TRSを再開したが,再び心機能が低下した進行乳癌の1例を経験したので報告する。症例は52歳,女性。左乳癌[T4bN3cM0, StageⅢC,invasive ductal carcinoma,ER(100%),PgR(50%),HER2(3+)]に対し,FEC 4サイクル,DOC+TRS 4サイクルの術前化学療法を施行し,乳房円状部分切除術と腋窩リンパ節郭清を施行した。術後補助化学療法としてTRSと内分泌療法を開始し,同時に左残存乳房に放射線照射を追加した。TRS 5サイクル後に動悸を認め,LVEFが64%から45.3%に低下したためいったん投与中止とした。2か月後に症状が消失し,LVEFも53%まで改善したのでTRSを再開したが再び動悸が出現し,LVEFも44%まで低下したため,投与中止とした。HERA試験の心機能アルゴリズムによるとLVEFが50%以上になれば投与再開とされているが,アンスラサイクリン系薬剤や放射線の治療歴などリスクを伴う症例はTRSの投与再開に際してより慎重であるべきと考えられた。
目次
Summary
Here we present a case of breast cancer in which cardiac dysfunction had previously been observed on trastuzumab(TRS)administration; the condition then improved but reoccurred on readministration of TRS. A 52-year-old woman received preoperative chemotherapy for StageⅢC left breast cancer(fluorouracil, epirubicin and cyclophosphamide followed by docetaxel and TRS), and then underwent partial mastectomy and axillary lymph node dissection. For adjuvant therapy, she received endocrine therapy and TRS. Radiation therapy was administered to the left residual breast. The patient complained about palpitation in the 5th cycle of TRS, and left ventricle ejection fraction(LVEF)decreased to 45.3% from 64%. Therefore, we stopped TRS administration. Palpitation improved, and LVEF increased to 53% after 2 months. TRS was administered again; however, palpitation reoccurred and LVEF decreased to 44%. TRS administration was once again discontinued. However, according to the HERA trial report regarding patients with a history of anthracycline and radiation therapy, TRS administration could be resumed when LVEF is greater than 50%, but we should be more careful during readministration of TRS.
要旨
trastuzumab(TRS)によって心機能が低下し,改善後TRSを再開したが,再び心機能が低下した進行乳癌の1例を経験したので報告する。症例は52歳,女性。左乳癌[T4bN3cM0, StageⅢC,invasive ductal carcinoma,ER(100%),PgR(50%),HER2(3+)]に対し,FEC 4サイクル,DOC+TRS 4サイクルの術前化学療法を施行し,乳房円状部分切除術と腋窩リンパ節郭清を施行した。術後補助化学療法としてTRSと内分泌療法を開始し,同時に左残存乳房に放射線照射を追加した。TRS 5サイクル後に動悸を認め,LVEFが64%から45.3%に低下したためいったん投与中止とした。2か月後に症状が消失し,LVEFも53%まで改善したのでTRSを再開したが再び動悸が出現し,LVEFも44%まで低下したため,投与中止とした。HERA試験の心機能アルゴリズムによるとLVEFが50%以上になれば投与再開とされているが,アンスラサイクリン系薬剤や放射線の治療歴などリスクを伴う症例はTRSの投与再開に際してより慎重であるべきと考えられた。