Rapid occurrence of left ventricular thrombus associated with platinum-based chemotherapy plus cetuximab for the treatment of metastatic squamous cell carcinoma of the head and neck: A case report

Abstract

Abstract. Platinum-based chemotherapy plus cetuximab represents the first-line treatment for recurrent or metastatic squamous cell carcinoma of the head and neck. The most common adverse events associated with cetuximab are infusion reactions and skin reactions, and a risk of venous thromboembolic events has also recently been reported in association with cetuximab. It is well known that thrombosis is a common complication of malignancy, and represents the second most frequent cause of mortality in cancer patients. The present study reports the case of a 79-year-old man who presented with lung and liver metastases from tongue squamous cell carcinoma, for which platinum-based chemotherapy plus cetuximab was administered. After 1 cycle, the patient showed rapid growth of a left ventricular (LV) thrombus, despite ongoing antiplatelet therapy for an old myocardial infarction. Anticoagulant therapy was administered to treat the LV thrombus, which resolved within 1 week. To the best of our knowledge, this represents the first reported case of rapidly occurring LV thrombus associated with platinum-based chemotherapy plus cetuximab. Platinum-based chemotherapy plus cetuximab may be associated with a higher risk of embolic thrombus. IntroductionPlatinum-based chemotherapy plus cetuximab represents the first-line treatment for recurrent or metastatic squamous cell carcinoma (SCC) of the head and neck (1). In the European Phase III EXTREME trial of patients with recurrent or metastatic SCC of the head and neck, the addition of cetuximab to platinum/5-fluorouracil (5-FU) in the first-line setting significantly improved the rates of overall survival, progression-free survival and overall response compared with platinum/5-FU alone (1). However, cetuximab treatment is associated with certain adverse events, the most common of which are infusion reactions and skin reactions. Additionally, a risk of venous thromboembolic events (VTEs) has recently been reported in association with cetuximab (1). It has been suggested that the association between cetuximab and risk of thrombosis may be due to the antiangiogenic effects of cetuximab (2).VTEs are considered to be under-diagnosed, as patients are typically asymptomatic at presentation and are often only diagnosed incidentally (2). A previous study reported that the majority of VTEs (92%) were identified during radiological examinations scheduled for tumor reevaluation (3).The present study reports the case of a 79-year-old man who presented with lung and liver metastases from a tongue SCC, and suffered rapid growth of a left ventricular (LV) thrombus following 1 cycle of platinum-based chemotherapy plus cetuximab. Anticoagulant therapy was administered to treat the LV thrombus, which resolved within 1 week. The current report highlights the potential association between platinum-based chemotherapy plus cetuximab and the increased risk of embolic thrombus. Case reportA 77-year old male patient initially presented to Department of Oral and Maxillofacial Reconstructive Surgery, Okayama

Could a Cutaneous Lesion Mean Gastric Cancer? Case Report of a Rare Diagnostic Tool and the Management of a Cardiac Complication during Chemotherapy

“…Reports of intracardiac thrombus following cisplatin-based regimens and 5-FU, although rare, can be found in the literature [13] [14] [15], but very little is available on the safety of the continuation of treatment in these cases, as many patients don't survive or are not fit enough for therapy afterwards. On the case reported by Ikeda et al, the patient resumed therapy after resolution on the thrombus, which was not possible in our patient [16]. Kaul et al reported a case in which the patient was severely symptomatic, justifying the need for surgical removal of the thrombus before adjuvant chemotherapy [17].…”

Multiple Complications Secondary to L-asparaginase In a Child with Philadelphia-Chromosome-Positive Acute Lymphoblastic Leukemia: Case Report with Review of Literature

“…In adults the preferred anticoagulation is usually oral warfarin along with low dose aspirin for 3 to 6 months. 23 Surgery is recommended if the general condition of the patient is preserved. Since our patient was a child who had undergone a major gastric surgery, he was commenced on subcutaneous LMWH and since he was severely neutropenic it was decided to defer any cardiac surgery until the time of count recovery.…”

“…19,20 Amongst adults, LV thrombus commonly occurs following myocardial infarction but has also occasionally been described amongst patients with cancer. [21][22][23] LV thrombus poses a risk of embolism resulting in ischemic stroke and peripheral embolism, because of which immediate anticoagulation therapy is recommended. In adults the preferred anticoagulation is usually oral warfarin along with low dose aspirin for 3 to 6 months.…”

How to Treat Today? Oral and Facial Cancer-Associated Venous Thromboembolism

“…Furthermore, other general factors, such as venous stasis due to tumor mass compression, infections, and hospital-stay-related immobilization, may contribute to the increased risk of VTE in patients with oral cancer. Finally, surgery for oral cancer often involves long procedures, especially in cases of simultaneous reconstruction, leading to prolonged hospitalization and bed rest, and cytostatic drug therapy was also related to an increased risk of thrombotic events in patients with oral cancer [ 16 , 17 , 18 ]. In a retrospective study of patients with head and neck cancer, the incidence of VTE in patients who underwent reconstruction after cancer resection ranged from 1.4 to 5.8%, and the main predictors for VTE were elderly, prior thrombosis, obesity, and the need for blood transfusion [ 19 ].…”