Trastuzumab-induced acute cardiotoxic event in breast cancer patient - a clinical case
Chemotherapy is one of the main treatments for cancer patients. Meanwhile, the frequency of cardiovascular complications associated with chemotherapy has incremented. The report is aimed to present a case of acute cardiotoxicity developed in Breast cancer patient during the treatment with Trastuzumab. Patient aged 61, diagnosed with left Breast cancer, was admitted to the hospital for planned chemotherapy. Oncologic diagnosis: Nodular invasive carcinoma of the left breast. St I. T1NxM0. Condition after radical mastectomy and a course of radiation treatment. Immunohistochemistry conclusion: HER-2 positive. Trastuzumab was prescribed in a routine regime, once in three weeks, course of 18 procedures. After four months of chemotherapy, she experienced weakness, a headache, dizziness, tachycardia, shortness of breath. ECG records: frequent ventricular extrasystoles, unstable ventricular tachycardia. LVEF decreased to 56% from 69% at baseline. The patient was admitted to the Cardiology division with a diagnosis of "paroxysm of ventricular tachycardia". Data on Holter monitoring: 435 episodes of paroxysm of unstable monomorphic ventricular tachycardia with a frequency of 126-206 beats/min. Treatment under conditions of Intensive Care Unit: Infusion of Santodarone 600 mg, Magnesium sulfate, Bisoprolol 5 mg. After seven days, she has discharged for further outpatient treatment with improvement. Subsequently, patient C. was transferred to the Cardiology division. Seven days later, she has discharged with improvement for further outpatient treatment with recommendations of Bisoprolol 5 mg, Valsartan 80 mg, Rosuvastatin 20 mg, Omacor 1000 mg, Trimetazidine 80 mg uptake. In total, patient C. received 13 courses of Trastuzumab instead of 18 (75%). Conclusion: Thus, the presented clinical case revealed disadvantages of the currently practiced clinical approach to cancer patients with prescribed chemotherapy: EchoCG cannot solely provide proper cardiac monitoring to prevent unfavorable cardiotoxic events successfully. New effective methods to prevent cardiotoxicity at an early stage, such as cardiac biomarkers and global longitudinal myocardial deformation assessment, should come into everyday practice.