Cardiotoxicity with trabectedin in the treatment of advanced soft tissue sarcoma

Doherty, Gary J.; Davidson, Dochka; Wong, Hock Tsen; Hatcher, Helen

doi:10.1097/cad.0000000000000693

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Cardiotoxic effects of chemotherapy could be acute in which they occur from the initiation of cancer treatment up to 2 weeks after completion of therapy; it is early chronic if they appear more than 2 weeks but less than 1 year of completion of treatment, and late chronic if more than 1 year of treatment [21]. Mechanisms of chemotherapy-induced cardiotoxicity include direct cellular injury resulting in structural changes that can impair ejection fraction, arrhythmias and inflammation involving the myocardium with/or pericardium [21,22].…”

Section: Discussionmentioning

confidence: 99%

Possible Lurbinectedin-associated Cardiotoxicity in a Patient with Metastatic Small Cell Lung Cancer: A Case Report

2023

Ann med clin Oncol

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Background: It has been a major challenge finding an effective second-line therapy with a favorable safety profile for metastatic small cell lung cancer (SCLC) in patients who failed or relapsed following first-line platinum-based chemotherapy. Lurbinectedin was approved for SCLC in patients who relapsed or failed first-line treatment. The most common adverse event associated with it was myelosuppression. Till date, no cardiotoxicity has been described with this medication in the literature. Case PresentationWe report an unusual case of acute cardiotoxicity following commencement of lurbinectedin in a 51-year old female with a history of metastatic SCLC, who despite receiving platinum-based dual chemotherapy durvalumab, continued to show progression of the disease. She presented to the ER 2 days after receiving lurbinectedin, with sudden onset of shortness of breath, hypotension and tachycardia. Electrocardiogram showed sinus tachycardia, troponin was elevated and echocardiogram revealed severely reduced systolic function and diffuse hypokinesis with no identifiable regional variations. Lurbinectedin was discontinued. She was intubated due to worsening respiratory distress, started on vasopressors and pulse dose methylprednisolone. Repeat echocardiogram showed improved systolic function (55% -60%). Her clinical condition also improved and she was successfully intubated. After extensive discussion about goals of care, the decision was to make the patient comfortable and DNR/DNI. She however unfortunately expired a few days after. Conclusion:Clinicians and Oncologists should be aware of the potential of lurbinectedin to cause cardiotoxicity and further observational studies are needed to examine this association.

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Section: Discussionmentioning

confidence: 99%

Possible Lurbinectedin-associated Cardiotoxicity in a Patient with Metastatic Small Cell Lung Cancer: A Case Report

2023

Ann med clin Oncol

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“…Post-marketing surveillance using the World Health Organization VigiBase revealed that there were significantly more events than expected up to August 2020 (Table 2 ) [ 6 ]. Case reports and series have shown wide variation in the clinical presentation from myocardial infarcts to exacerbations of heart failure with preserved ejection fraction (Table 2 ) [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…In case 3, there was no obvious AF trigger; however, these patients are predisposed due to systemic disease, underlying inflammation, and increased risk of electrolyte abnormalities. In the case series by Doherty et al [ 7 ], the 2 patients who developed AF had a clear arrhythmogenic trigger with masses abutting the pericardium.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent adverse effects in early trials were hepatic toxicity, gastro-intestinal symptoms, and myelosuppression [ 1 , 4 ]. Trabectedin was not initially reported to be cardiotoxic; however, this is an increasingly recognized phenomenon with its widespread use outside clinical trial settings [ 5 , 6 , 7 ]. Here, we present our institutional experience of trabectedin-related cardiac events to help physicians identify and treat this toxicity.…”

Section: Introductionmentioning

confidence: 99%

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Trabectedin Cardiotoxicity in Soft Tissue Sarcoma: A Case Series and Clinical Insights

Gent¹,

Ali²,

Olsson‐Brown³

et al. 2022

Case Rep Oncol

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Trabectedin is a chemotherapeutic used to treat advanced soft tissue sarcoma and relapsed platinum-sensitive ovarian cancer. Although it is associated with a low incidence of cardiotoxicity, when this occurs it can be fatal or significantly compromise the quality of life in patients with advanced cancer. Here, we present a series of 4 cases where trabectedin-treated sarcoma patients developed cardiovascular complications. Similar to previous literature describing this association, all patients had prior treatment with anthracyclines and presented at different time points following treatment initiation. Each patient presented with exertional breathlessness and was found to have severely impaired left ventricular systolic function (ejection fraction ≤35%), and 1 patient had concurrent atrial fibrillation with a fast ventricular rate. All of the patients were treated with neurohormonal blockade, and a multi-disciplinary decision was made to stop trabectedin in 3 patients and continue in 1 patient. Two of the 4 patients had an improvement in their left ventricular systolic function. It is unclear what effect preceeding anthracycline or tyrosine kinase inhibitor treatment has in priming patients to develop cardiotoxicity in this setting. Our case series adds to the evidence surrounding this association and highlights that trabectedin-associated cardiotoxicity can present in an insidious fashion.

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Doxorubicin/doxorubicin liposomal/trabectedin

2019

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Cardiotoxicity with trabectedin in the treatment of advanced soft tissue sarcoma

Cited by 6 publications

References 11 publications

Possible Lurbinectedin-associated Cardiotoxicity in a Patient with Metastatic Small Cell Lung Cancer: A Case Report

Possible Lurbinectedin-associated Cardiotoxicity in a Patient with Metastatic Small Cell Lung Cancer: A Case Report

Trabectedin Cardiotoxicity in Soft Tissue Sarcoma: A Case Series and Clinical Insights

Doxorubicin/doxorubicin liposomal/trabectedin

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