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Entrectinib-Induced Myocarditis and Acute Heart Failure Responding to Steroid Treatment: A Case Report
Mehraab N Majeed1, Subramanian Venkatesan1, Dionysis Papadatos-Pastos1
1Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom.
JTO Clinical and Research Reports
|November 25, 2024
Summary
This case report details a patient experiencing entrectinib-induced myocarditis and heart failure, successfully treated with steroids. It highlights the importance of recognizing cardiotoxicity from ROS1 inhibitors.
Area of Science:
- Oncology
- Cardiology
- Pharmacology
Background:
- A 72-year-old man with recurrent ROS1-positive Non-Small Cell Lung Cancer (NSCLC) was treated with entrectinib.
- The patient had a history of early-stage NSCLC treated radically 8 years prior.
- He had pre-existing chronic kidney disease, complicating treatment.
Observation:
- The patient developed recurrent acute kidney injuries during entrectinib treatment.
- Despite withholding entrectinib, he experienced worsening dyspnea and edema, progressing to acute pulmonary edema.
- Cardiac investigations confirmed acute myocarditis and heart failure.
Findings:
- Standard heart failure treatment was ineffective.
- A short course of prednisolone led to symptom resolution, improved cardiac biomarkers (N-terminal pro B-type natriuretic peptide), and recovery of left ventricular ejection fraction.
- This is the third reported case of entrectinib-induced myocarditis and the first successfully managed with steroids.
Implications:
- Entrectinib-induced cardiotoxicity is a significant adverse event requiring awareness, especially given potential asymptomatic onset.
- Steroid therapy may be an effective treatment for entrectinib-induced myocarditis and heart failure.
- Crizotinib was a well-tolerated alternative treatment option.
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