Entrectinib-Induced Myocarditis and Acute Heart Failure Responding to Steroid Treatment: A Case Report
A 72-year-old man presented to his general practitioner with worsening dyspnea and was diagnosed with having recurrent ROS1-positive stage IIIB NSCLC 8 years after initial diagnosis and radical treatment for early stage disease. He was subsequently started on entrectinib but required hospital admiss...
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| Format: | Article |
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Elsevier
2024-12-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364324001164 |
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| author | Mehraab N. Majeed, MBBCh Subramanian Venkatesan, PhD Dionysis Papadatos-Pastos, PhD Tanya Ahmad, MD Martin Forster, PhD Polyvios Demetriades, MRCP Daniel Johnathan Hughes, MRCP Sarah Benafif, PhD Siow Ming Lee, FRCP |
| author_facet | Mehraab N. Majeed, MBBCh Subramanian Venkatesan, PhD Dionysis Papadatos-Pastos, PhD Tanya Ahmad, MD Martin Forster, PhD Polyvios Demetriades, MRCP Daniel Johnathan Hughes, MRCP Sarah Benafif, PhD Siow Ming Lee, FRCP |
| author_sort | Mehraab N. Majeed, MBBCh |
| collection | DOAJ |
| description | A 72-year-old man presented to his general practitioner with worsening dyspnea and was diagnosed with having recurrent ROS1-positive stage IIIB NSCLC 8 years after initial diagnosis and radical treatment for early stage disease. He was subsequently started on entrectinib but required hospital admissions for recurrent acute kidney injuries on a background of chronic kidney disease. His entrectinib was withheld on day 20 since his first dose of treatment while he was being investigated. Nevertheless, he continued to experience worsening dyspnea and bilateral pedal edema and later developed acute pulmonary edema 31 days after his first dose of entrectinib, despite the drug being withheld for the past 11 days. Results of biochemical tests and cardiac imaging confirmed acute myocarditis. Initially, he was treated with standard heart failure medications without clinical improvement or decline in N-terminal pro B-type natriuretic peptide levels. Nevertheless, he noticed significant improvement after starting a short course of prednisolone, which led to complete resolution of symptoms, improved N-terminal pro B-type natriuretic peptide levels, and recovery of left ventricular ejection fraction. His treatment was subsequently changed to crizotinib, which was well tolerated. This is the third reported case of entrectinib-induced myocarditis and the first reported case which has been successfully managed with steroid therapy. This case was also associated with concurrent acute heart failure after entrectinib treatment which responded promptly to prednisolone (40 mg). Entrectinib-induced cardiotoxicity is an important adverse event to be aware of, particularly as patients may be asymptomatic for an initial period before significant deterioration. |
| format | Article |
| id | doaj-art-b022d0fdc0cb4dc2a6af6f341d77fb22 |
| institution | Kabale University |
| issn | 2666-3643 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj-art-b022d0fdc0cb4dc2a6af6f341d77fb222024-12-09T04:28:09ZengElsevierJTO Clinical and Research Reports2666-36432024-12-01512100746Entrectinib-Induced Myocarditis and Acute Heart Failure Responding to Steroid Treatment: A Case ReportMehraab N. Majeed, MBBCh0Subramanian Venkatesan, PhD1Dionysis Papadatos-Pastos, PhD2Tanya Ahmad, MD3Martin Forster, PhD4Polyvios Demetriades, MRCP5Daniel Johnathan Hughes, MRCP6Sarah Benafif, PhD7Siow Ming Lee, FRCP8Department of Oncology, University College London Hospital NHS Foundation Trust, London, United KingdomDepartment of Oncology, University College London Hospital NHS Foundation Trust, London, United KingdomDepartment of Oncology, University College London Hospital NHS Foundation Trust, London, United KingdomDepartment of Oncology, University College London Hospital NHS Foundation Trust, London, United KingdomDepartment of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom; University College London Cancer Institute, London, United KingdomBarts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United KingdomDepartment of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom; University College London Medical School, London, United KingdomDepartment of Oncology, University College London Hospital NHS Foundation Trust, London, United KingdomDepartment of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom; University College London Cancer Institute, London, United Kingdom; Corresponding author. Address for correspondence: Siow Ming Lee, FRCP, University College London Hospital NHS Foundation Trust, London, United Kingdom.A 72-year-old man presented to his general practitioner with worsening dyspnea and was diagnosed with having recurrent ROS1-positive stage IIIB NSCLC 8 years after initial diagnosis and radical treatment for early stage disease. He was subsequently started on entrectinib but required hospital admissions for recurrent acute kidney injuries on a background of chronic kidney disease. His entrectinib was withheld on day 20 since his first dose of treatment while he was being investigated. Nevertheless, he continued to experience worsening dyspnea and bilateral pedal edema and later developed acute pulmonary edema 31 days after his first dose of entrectinib, despite the drug being withheld for the past 11 days. Results of biochemical tests and cardiac imaging confirmed acute myocarditis. Initially, he was treated with standard heart failure medications without clinical improvement or decline in N-terminal pro B-type natriuretic peptide levels. Nevertheless, he noticed significant improvement after starting a short course of prednisolone, which led to complete resolution of symptoms, improved N-terminal pro B-type natriuretic peptide levels, and recovery of left ventricular ejection fraction. His treatment was subsequently changed to crizotinib, which was well tolerated. This is the third reported case of entrectinib-induced myocarditis and the first reported case which has been successfully managed with steroid therapy. This case was also associated with concurrent acute heart failure after entrectinib treatment which responded promptly to prednisolone (40 mg). Entrectinib-induced cardiotoxicity is an important adverse event to be aware of, particularly as patients may be asymptomatic for an initial period before significant deterioration.http://www.sciencedirect.com/science/article/pii/S2666364324001164Tyrosine kinase inhibitorEntrectinibMyocarditisAcute heart failureROS-1Case report |
| spellingShingle | Mehraab N. Majeed, MBBCh Subramanian Venkatesan, PhD Dionysis Papadatos-Pastos, PhD Tanya Ahmad, MD Martin Forster, PhD Polyvios Demetriades, MRCP Daniel Johnathan Hughes, MRCP Sarah Benafif, PhD Siow Ming Lee, FRCP Entrectinib-Induced Myocarditis and Acute Heart Failure Responding to Steroid Treatment: A Case Report JTO Clinical and Research Reports Tyrosine kinase inhibitor Entrectinib Myocarditis Acute heart failure ROS-1 Case report |
| title | Entrectinib-Induced Myocarditis and Acute Heart Failure Responding to Steroid Treatment: A Case Report |
| title_full | Entrectinib-Induced Myocarditis and Acute Heart Failure Responding to Steroid Treatment: A Case Report |
| title_fullStr | Entrectinib-Induced Myocarditis and Acute Heart Failure Responding to Steroid Treatment: A Case Report |
| title_full_unstemmed | Entrectinib-Induced Myocarditis and Acute Heart Failure Responding to Steroid Treatment: A Case Report |
| title_short | Entrectinib-Induced Myocarditis and Acute Heart Failure Responding to Steroid Treatment: A Case Report |
| title_sort | entrectinib induced myocarditis and acute heart failure responding to steroid treatment a case report |
| topic | Tyrosine kinase inhibitor Entrectinib Myocarditis Acute heart failure ROS-1 Case report |
| url | http://www.sciencedirect.com/science/article/pii/S2666364324001164 |
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