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Cardiotoxicidad permisiva en cáncer de mama metastásico HER2-positivo con disfunción ventricular izquierda moderada
Humza Rashid1, Pramukh Arun Kumar2, Agnes S Kim2
1School of Medicine, University of Connecticut, Farmington, Connecticut, USA.
JACC. Case reports
|February 19, 2026
Resumen
La terapia médica dirigida por guías (GDMT, por sus siglas en inglés) puede ayudar a los pacientes con cáncer de mama HER2-positivo a recuperar la función cardíaca, permitiendo la continuación del tratamiento. La atención de cardiooncología equilibra el tratamiento del cáncer con la seguridad cardíaca.
Área de la Ciencia:
- Cardiooncología
- Investigación del cáncer de mama
- Medicina cardiovascular
Sus antecedentes:
- La cardiotoxicidad permisiva es una preocupación creciente en el cáncer de mama HER2-positivo.
- Las ventajas oncológicas de las terapias dirigidas a HER2 pueden justificar los riesgos cardíacos.
Objetivo del estudio:
- Ilustrar el manejo del cáncer de mama HER2-positivo con cardiotoxicidad.
- Destacar el papel de la terapia médica dirigida por guías (GDMT) en el manejo de la disfunción cardíaca durante el tratamiento dirigido a HER2.
Principales métodos:
- Estudio de caso de una mujer de 49 años con cáncer de mama metastásico HER2-positivo que experimentó disfunción sistólica del ventrículo izquierdo y regurgitación mitral.
- Cese temporal de la terapia HER2 (trastuzumab y pertuzumab) e inicio de GDMT.
- Reanudación de la terapia HER2 bajo estrecha vigilancia después de la recuperación cardíaca parcial.
Principales resultados:
- La paciente desarrolló disfunción sistólica moderada del ventrículo izquierdo (FEVI 38%) y regurgitación mitral.
- La GDMT condujo a una recuperación cardíaca parcial (la FEVI mejoró a 52%).
- La terapia HER2 se reanudó de forma segura con GDMT, a pesar de una FEVI inicial <40%.
Conclusiones:
- El consenso multidisciplinario apoyó la reanudación de la terapia HER2 basándose en la recuperación cardíaca y la carga de la enfermedad.
- La GDMT facilita la continuación del tratamiento dirigido a HER2 en pacientes con disfunción ventricular izquierda asintomática.
- La atención integrada de cardiooncología es crucial para equilibrar los objetivos oncológicos y la seguridad cardiovascular.
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