Hasan Şenol COŞKUN, Melek KARAKURT ERYILMAZ, Derya KIVRAK SALİM, Fatma YALÇIN MÜSRİ, Hasan MUTLU

Meme Kanserli Bir Hastada Adjuvan Anastrozole Bağlı İrreversible Kalp Yetmezliği

Adjuvan hormonoterapi östrojen ve/veya progesteron reseptör pozitif erken evre meme kanseri MK tedavisinde önemli bir rol oynamaktadır. Bu olgu da daha önceden bilinen kalp rahatsızlığı olmayan ve bir yıl önce hormon reseptör pozitif evre IIIA MK tanısı almış bir hasta sunulmaktadır. Hasta adjuvan kemo-radyoterapi ve ardından letrozol ile tedavi edilmiştir. Letrozole bağlı eklem ağrısı sebebiyle hastanın tedavisi 1 mg/gün anastrozol olarak değiştirilmiştir. İki aylık tedavi sonrası hastada kalp yetmezliği gelişmiş olup anastrazol kullanımı bırakılmıştır. Buna rağmen hastanın ejeksiyon fraksiyonunda herhangi bir iyileşme saptanmamıştır. Aromataz inhibitörleri kalp rahatsızlığı olan MK hastalarında dikkatle kullanılmalı ve transtuzumab gibi kardiyotoksik ajanlar ile kombinasyon durumlarında daha dikkatli olunmalıdır

Anahtar Kelimeler:

Meme kanseri, Aromataz inhibitörü, Kalp yetmezliği

Irreversible Heart Failure Related to Adjuvant Anastrozole in a Patient with Breast Cancer

Adjuvant hormonal therapy plays a major role in the treatment of estrogen and/or progesterone receptorpositive early stage breast cancer BC . In this case report, we present a postmenopausal patient who had no known history of heart disease and was diagnosed with hormone receptor-positive stage IIIA breast cancer one year ago. She was treated with adjuvant chemo-radiotherapy followed by letrozole. Because of letrozole-induced joint pain, her medication was switched to anastrazole 1 mg/day. After two months of treatment with anastrozole, the patient developed heart failure and anastrazole was discontinued. Despite discontinuation of anastrazole, no improvement was seen in the ejection fraction. Aromatase inhibitors should be used carefully in patients with BC who have a cardiac disorder and care should also be exercised in cases of combination with other cardiotoxic drugs such as trastuzumab

Keywords:

Breast cancer, Aromatase inhibitors, Heart failure,

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Curado MP. Breast cancer in the world: Incidence and mortality. Salud Publica Mex 2011; 53: 372-84.
Perou CM, Sİrlie T, Eisen MB, Van de Rijn M, Jeffrey SS, Rees CA, Pollack JR, Ross DT, Johnsen H, Akslen LA, Fluge O, Pergamenschikov A, Williams C, Zhu SX, Lİnning PE, Bİrresen-Dale AL, Brown PO, Botstein D. Molecular portraits of human breast tumours. Nature 2000; 406: 747-52.
Aebi S, Davidson T, Gruber G, Castiglione M. Primary breast cancer: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up. Ann Oncol 2011; 22Suppl 6:vi12-24.
Amir E, Seruga B, Niraula S, Carlsson L, Ocaña A. Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: A systematic review and meta- analysis. J Natl Cancer Inst 2011; 103: 1299-309.
Burstein HJ, Prestrud AA, Seidenfeld J, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, Giordano SH, Hudis CA, Malin J, Mamounas EP, Rowden D, Solky AJ, Sowers MR, Stearns V, Winer EP, Somerfield MR, Griggs JJ. American Society of Clinical Oncology Clinical Practice Guideline: Update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 2010; 28: 3784-96.
Niravath P, Rimawi MF, Osborne CK. Aromatase inhibitor adverse effects: Are we sweeping them under the rug? J Clin Oncol 2014; 32: 3779.
Nabholtz JM, Gligorov J. Cardiovascular safety profiles of aromatase inhibitors: A comparative review. Drug Saf 2006; 29: 785-801.
Elisaf MS, Bairaktari ET, Nicolaides C, Kakaidi B, Tzallas CS, Katsaraki A, Pavlidis NA. Effect of letrozole on the lipid profile in postmenopausal women with breast cancer. Eur J Cancer 2001; 37: 1510-3.
Ingle JN. Postmenopausal women with hormone receptor- positive breast cancer: balancing benefit and toxicity from aromatase inhibitors. Breast 2013; 22 Suppl 2:S180-3.
Franklin SS, Gustin W 4th, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 1997; 96:308-15.
Barrett-Lee PJ, Dixon JM, Farrell C, Jones A, Leonard R, Murray N, Palmieri C, Plummer CJ, Stanley A, Verrill MW. Expert opinion on the use of anthracyclines in patients with advanced breast cancer at cardiac risk. Ann Oncol 2009 ;20:816-27.
Von Hoff DD, Layard MW, Basa P, Davis HL Jr, Von Hoff AL, Rozencweig M, Muggia FM. Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med 1979;91(5):710-7.
Lipshultz SE, Colan SD, Gelber RD, Perez-Atayde AR, Sallan SE, Sanders SP. Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood. N Engl J Med 1991;324(12):808-15.