A Importância do Monitoramento e da Identificação Precoce de Cardiotoxicidade do Tratamento com Trastuzumabe no Câncer de Mama: Relato de Caso

Abstract

Introdução: O câncer de mama representa a neoplasia mais frequente entre as mulheres, com elevada morbimortalidade. Com o advento de novos medicamentos, houve um aumento na sobrevida global; entretanto, o trastuzumabe, um anticorpo monoclonal utilizado no tratamento, pode promover cardiotoxicidade, que deve ser avaliada e monitorada durante o tratamento. O objetivo deste artigo é descrever um relato de caso de paciente que apresentou cardiotoxicidade associada ao uso de trastuzumabe e a importância do monitoramento e da identificação precoce da cardiotoxicidade por meio do monitoramento pelo ecocardiograma (ECO). Relato do caso: Paciente, sexo feminino, 63 anos, hipertensa, obesa, com câncer de mama, apresentou cardiotoxicidade associada ao uso de trastuzumabe, com redução da fração de ejeção do ventrículo esquerdo (FEVE) e desenvolveu diabetes após o tratamento. A paciente fez acompanhamento regular pelo ECO durante o tratamento, tendo sido esse processo fundamental para a detecção precoce e o manejo adequado da cardiotoxicidade associada ao uso do trastuzumabe. Foi utilizado um algoritmo na determinação da causalidade. Conclusão: Este estudo mostra a importância do acompanhamento da FEVE pelo ECO em pacientes submetidas à quimioterapia cardiotóxica, e do monitoramento de possíveis alterações metabólicas após o tratamento oncológico.

Monoclonal-induced cardiotoxicity in patients with non-Hodgkin's lymphoma and breast cancer: A retrospective study in an oncology clinic

“…1,2 Oncological cardiotoxicity can be characterized by the development of heart failure (HF) with systolic ventricular dysfunction, cardiomyopathy, ischemia, changes in blood pressure (hypotension or hypertension), thickening or instability in pericardial fluid balance, leading to infarction, in addition to increasing the risk of arrhythmia, among other manifestations. 2,3 Left ventricular dysfunction (LVD), reduced left ventricular ejection fraction (LVEF), and HF can lead to discontinuation, dose reduction, or interruption of therapy. 4 Among the main risk factors for the development of cardiotoxicity, the following stand out: female sex, age ≥60 years, systemic arterial hypertension (SAH), obesity, previous use of anthracyclines, radiotherapy ≥50 gray (Gy), mediastinal irradiation, previous history of LVD and or baseline LVEF ≤50%, and smoking.…”

“…4 Among the main risk factors for the development of cardiotoxicity, the following stand out: female sex, age ≥60 years, systemic arterial hypertension (SAH), obesity, previous use of anthracyclines, radiotherapy ≥50 gray (Gy), mediastinal irradiation, previous history of LVD and or baseline LVEF ≤50%, and smoking. [3][4][5] Cardiotoxic antineoplastic drugs can cause irreversible or reversible injuries. Type I agents (anthracyclines and alkylating agents) can cause irreversible lesions and those that do not cause irreversible cell destruction, such as type II agents (trastuzumab and rituximab).…”

“…The need for pharmacological intervention may include beta-blockers (BBs), diuretics, or cardiac glycosides. [2][3][4][5]15 The multidisciplinary follow-up of these patients aims to ensure that early clinical manifestations of toxicity are managed early, in addition, that non-specific symptoms such as tiredness, fatigue, and functional limitation for day-to-day activities are not neglected. 4,11 In this context, this study analyzed cardiovascular ADR and the association between risk factors and the development of HF in onco-hematologic patients using rituximab and trastuzumab in a private oncology clinic.…”

“…Oncological cardiotoxicity can be characterized by the development of heart failure (HF) with systolic ventricular dysfunction, cardiomyopathy, ischemia, changes in blood pressure (hypotension or hypertension), thickening or instability in pericardial fluid balance, leading to infarction, in addition to increasing the risk of arrhythmia, among other manifestations. 2,3 Left ventricular dysfunction (LVD), reduced left ventricular ejection fraction (LVEF), and HF can lead to discontinuation, dose reduction, or interruption of therapy. 4…”

“…Among the main risk factors for the development of cardiotoxicity, the following stand out: female sex, age ≥60 years, systemic arterial hypertension (SAH), obesity, previous use of anthracyclines, radiotherapy ≥50 gray (Gy), mediastinal irradiation, previous history of LVD and or baseline LVEF ≤50%, and smoking. 3–5…”