Unexpected Cardiotoxicity in Patients With HER2-Mutant NSCLC Treated With Trastuzumab Deruxtecan: A Case Report

Area of Science:

• Oncology
• Cardiology
• Pharmacology

Background:

• Receptor tyrosine-protein kinase erbB-2 (HER2)-targeted therapies, including antibody-drug conjugates, offer new treatment avenues for HER2-mutant non-small cell lung cancer (NSCLC).
• Trastuzumab deruxtecan demonstrates significant efficacy in HER2-mutant NSCLC, positioning it as a potential new standard of care.
• Interstitial lung disease is a known, serious risk associated with trastuzumab deruxtecan, necessitating vigilant monitoring and multidisciplinary management.

Observation:

• This report details the first two cases of drug-related cardiotoxicity, specifically acute myocarditis, observed in patients treated with trastuzumab deruxtecan.
• These cardiac events occurred shortly after the initial cycle of trastuzumab deruxtecan therapy.
• The observed cardiotoxicity underscores a previously less-characterized adverse event profile for this targeted therapy.

Findings:

• Trastuzumab deruxtecan, while effective, is associated with a risk of acute myocarditis.
• Early detection and management of cardiac adverse events are crucial for patients receiving trastuzumab deruxtecan.
• The incidence and mechanisms of trastuzumab deruxtecan-induced cardiotoxicity require further investigation.

Implications:

• Routine cardiovascular risk screening should be implemented for patients undergoing treatment with trastuzumab deruxtecan.
• Close collaboration between oncologists and cardiologists is essential for optimal patient care and management of potential cardiotoxicity.
• These findings necessitate a re-evaluation of safety protocols and patient monitoring strategies for HER2-targeted antibody-drug conjugates.