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Blancas I, Linares-Rodríguez M, Martín-Bravo C, Gómez-Peña C, Rodríguez-Serrano F. HER2/neu 655 polymorphism, trastuzumab-induced cardiotoxicity, and survival in HER2-positive breast cancer patients. Clin Transl Oncol 2024:10.1007/s12094-024-03512-6. [PMID: 38771533 DOI: 10.1007/s12094-024-03512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE HER2 overexpression in breast cancer correlates with poor outcomes. The incorporation of Trastuzumab into the treatment regimen has notably improved patient prognoses. However, cardiotoxicity emerges in approximately 20% of patients treated with the drug. This study aims to investigate the association between the HER2 655 A > G polymorphism, Trastuzumab-induced cardiotoxicity, and patient survival. METHODS The study involved 88 patients treated with Trastuzumab. Cardiotoxicity, defined as a reduction in left ventricular ejection fraction (LVEF) from baseline or the emergence of clinical signs of congestive heart failure, was identified during treatment follow-up. Genotyping of HER2 655 A > G employed TaqMan SNP technology. RESULTS Genotype frequencies of HER2/neu 655 (53 AA, 32 AG, and 3 GG) were consistent with Hardy-Weinberg equilibrium. No significant differences were observed in mean baseline LVEF between patients who developed cardiotoxicity and those who did not. Within these groups, neither AA nor AG genotypes showed an association with changes in mean baseline or reduced LVEF levels. Logistic regression analysis, adjusted for hormonal status and anthracycline treatment, revealed that AG genotype carriers face a significantly higher risk of cardiotoxicity compared to AA carriers (OR = 4.42; p = 0.037). No association was found between the HER2/neu 655 A > G polymorphism and disease-free or overall survival, regardless of whether the data was adjusted for stage or not. CONCLUSION HER2 655 A > G polymorphism is significantly linked to an increased risk of Trastuzumab-induced cardiotoxicity but does not correlate with variations in disease-free survival or overall survival rates.
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Affiliation(s)
- Isabel Blancas
- Department of Medicine, University of Granada, Granada, Spain.
- Section of Medical Oncology, Hospital Universitario Clínico San Cecilio, Granada, Spain.
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Marina Linares-Rodríguez
- Biopathology and Regenerative Medicine Institute (IBIMER), Biomedical Research Centre, University of Granada, Avenida del Conocimiento S/N, 18016, Armilla, Granada, Spain
| | | | - Celia Gómez-Peña
- Department of Pharmacy, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Fernando Rodríguez-Serrano
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
- Biopathology and Regenerative Medicine Institute (IBIMER), Biomedical Research Centre, University of Granada, Avenida del Conocimiento S/N, 18016, Armilla, Granada, Spain.
- Department of Human Anatomy and Embryology, University of Granada, Granada, Spain.
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Wekking D, Porcu M, Pellegrino B, Lai E, Mura G, Denaro N, Saba L, Musolino A, Scartozzi M, Solinas C. Multidisciplinary clinical guidelines in proactive monitoring, early diagnosis, and effective management of trastuzumab deruxtecan (T-DXd)-induced interstitial lung disease (ILD) in breast cancer patients. ESMO Open 2023; 8:102043. [PMID: 37951130 PMCID: PMC10679891 DOI: 10.1016/j.esmoop.2023.102043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 11/13/2023] Open
Abstract
Trastuzumab deruxtecan (T-DXd), a human epidermal growth factor receptor 2 (HER2)-directed antibody-drug conjugate (ADC), has altered the treatment landscape in breast cancer (BC), irrespective of the HR-receptor status. The use of the agent is increasing, despite the finding that exposure to T-DXd increases the risk of interstitial lung disease (ILD), particularly in BC patients. Although T-DXd-related ILD can be potentially severe and life-threatening, most low-grade cases can be treated safely using a multidisciplinary approach comprising early and accurate diagnosis, effective management, close monitoring, and the prompt administration of steroids. Additionally, increasing patients' education on ILD symptoms ensures close attention and enables prompt reporting, enhancing patient outcomes. It is recommended that predictive biomarkers are assessed in patients with risk factors for developing ILD. Currently, diagnostic criteria comprise newly identified pulmonary opacities, the relation of symptom onset to medication initiation, and the exclusion of other causes of ILD. The general condition of patients is weakened during the management of ILD (BC progression and corticosteroid treatment). Consequently, BC chemotherapy might be attenuated. This highlights the importance of preventing (high-grade) ILD, especially since its use is expanded. Identifying high-risk patients, diagnosing, and customizing treatment is, however, challenging and additional information on patient selection is often not fully clarified. In this paper, we provide updated multidisciplinary clinical guidance for patient selection, proactive monitoring, early diagnosis, and effectively management of T-DXd-induced ILD in HER2-positive BC patients. We describe the risk factors for developing ILD, patients' characteristics of ILD, and the histopathological and radiographic characteristics of ILD, including real-world clinical practice reports. These recommendations provide a structured step-by-step approach for managing each suspected BC-related ILD grade.
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Affiliation(s)
- D Wekking
- Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - M Porcu
- Radiology Department, AOU Cagliari, Cagliari University, Policlinico di Monserrato, Monserrato (CA)
| | - B Pellegrino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica(GOIRC), Parma
| | - E Lai
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, Monserrato
| | - G Mura
- Anatomical Pathology, Valdes Laboratory, Cagliari
| | - N Denaro
- IRCCS Fondazone Ca' Granda Policlinico Milano, SC Oncologia, Milan, Italy
| | - L Saba
- Radiology Department, AOU Cagliari, Cagliari University, Policlinico di Monserrato, Monserrato (CA)
| | - A Musolino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica(GOIRC), Parma
| | - M Scartozzi
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, Monserrato
| | - C Solinas
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, Monserrato
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Huo B, Lin L, Zhao L, Yu R, Yang J. First reported case of ANCA-associated vasculitis induced by oxaliplatin, capecitabine, and trastuzumab. Ren Fail 2023; 45:2282710. [PMID: 37975167 PMCID: PMC11001309 DOI: 10.1080/0886022x.2023.2282710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
A 68-year-old male, who was undergoing XELOX plus trastuzumab therapy for gastric cancer, developed proteinuria, hematuria, and progressive increase in creatinine after 3 months. Subsequently, the patient also experienced hemoptysis, nasal bleeding. Chest CT examination shown pulmonary hemorrhage. The MRI of the nasopharynx ruled out nasopharyngeal cancer recurrence. The MPO and PR3 were elevated, and renal biopsy confirmed ANCA-related vasculitis, which affected the lungs, kidneys, and nasopharynx. Based on the review of the patient''s medical history and medication, it is believed that ANCA-related vasculitis was caused by XELOX plus trastuzumab chemotherapy, but it is difficult to confirm which specific drug caused it. After stopping XELOX plus trastuzumab chemotherapy, glucocorticoids and cyclophosphamide was given, the patient''s pulmonary hemorrhage and nasal bleeding stopped, and the lung lesions were absorbed. The renal function also improved. The patient later experienced pulmonary infection again, and tNGS indicated Legionella pneumophila and pulmonary tuberculosis infection. Despite anti-infection treatment, steroid dose was rapidly reduced. Ultimately, the patient gave up on treatment and eventually died.
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Affiliation(s)
- Bengang Huo
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
- Department of Nephrology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing, China
| | - Lirong Lin
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Lei Zhao
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Rongjie Yu
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
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Shang B, Cui H, Xie R, Wu J, Shi H, Bi X, Feng L, Shou J. Neutrophil extracellular traps primed intercellular communication in cancer progression as a promising therapeutic target. Biomark Res 2023; 11:24. [PMID: 36859358 PMCID: PMC9977644 DOI: 10.1186/s40364-023-00463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/08/2023] [Indexed: 03/03/2023] Open
Abstract
In addition to the anti-infection response, neutrophils are linked to tumor progression through the secretion of inflammation components and neutrophil extracellular traps (NETs) formation. NET is a web-like structure constituted by a chromatin scaffold coated with specific nuclear and cytoplasmic proteins, such as histone and granule peptides. Increasing evidence has demonstrated that NETs are favorable factors to promote tumor growth, invasion, migration, and immunosuppression. However, the cell-cell interaction between NETs and other cells (tumor cells and immune cells) is complicated and poorly studied. This work is the first review to focus on the intercellular communication mediated by NETs in cancer. We summarized the complex cell-cell interaction between NETs and other cells in the tumor microenvironment. We also address the significance of NETs as both prognostic/predictive biomarkers and molecular targets for cancer therapy. Moreover, we presented a comprehensive landscape of cancer immunity, improving the therapeutic efficacy for advanced cancer in the future.
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Affiliation(s)
- Bingqing Shang
- grid.506261.60000 0001 0706 7839Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuan Nanli 17# Chaoyang District, Beijing, 100021 PR China
| | - Honglei Cui
- grid.506261.60000 0001 0706 7839Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuan Nanli 17# Chaoyang District, Beijing, 100021 PR China
| | - Ruiyang Xie
- grid.506261.60000 0001 0706 7839Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuan Nanli 17# Chaoyang District, Beijing, 100021 PR China
| | - Jie Wu
- grid.506261.60000 0001 0706 7839Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuan Nanli 17# Chaoyang District, Beijing, 100021 PR China
| | - Hongzhe Shi
- grid.506261.60000 0001 0706 7839Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuan Nanli 17# Chaoyang District, Beijing, 100021 PR China
| | - Xingang Bi
- grid.506261.60000 0001 0706 7839Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuan Nanli 17# Chaoyang District, Beijing, 100021 PR China
| | - Lin Feng
- Department of Etiology and Carcinogenesis, State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR, China.
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuan Nanli 17# Chaoyang District, Beijing, 100021, PR, China.
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Mallah H, Altshuler E, Ramnaraign B, Khawaja A. Pneumocystis jirovecii pneumonia in a patient treated with trastuzumab-deruxtecan. BMJ Case Rep 2023; 16:e253647. [PMID: 36805876 PMCID: PMC9943902 DOI: 10.1136/bcr-2022-253647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Trastuzumab-deruxtecan (T-DXd) is a novel antibody drug conjugate that has improved treatment outcomes in patients with ERBB2-positive cancer, including locally advanced or metastatic gastric and gastro-oesophageal junction adenocarcinoma. One of the reported side effects of this medication is drug-induced pneumonitis. We present in this case report, a diagnostic dilemma of a patient presenting with clinical and radiographical features of drug-induced pneumonitis but was found to have pneumocystis jirovecii pneumonia (PJP). Our case is the first of PJP in a patient treated with T-DXd, highlighting the increasing incidence of this opportunistic infection in patients with solid malignancy. It also highlights the clinical and radiographical similarities between the PJP and drug-induced pneumonitis.
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Affiliation(s)
- Haneen Mallah
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Ellery Altshuler
- Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Brian Ramnaraign
- Hematology and Oncology, Universitry of Florida, Gainesville, Florida, USA
| | - Ali Khawaja
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA
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Cheng KH, Contreras GP, Yeh TY. Potential Role of Neutrophil Extracellular Traps in Cardio-Oncology. Int J Mol Sci 2022; 23:ijms23073573. [PMID: 35408933 PMCID: PMC8998890 DOI: 10.3390/ijms23073573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular toxicity has emerged as the leading cause of death in patients undergoing cancer treatment. Thus, cardio-oncology (CO) care must also focus on the prevention and management of related cardiovascular (CV) complications caused by cancer therapy. Neutrophil extracellular traps (NETs)—entities with released DNA, proteases, proinflammatory and prooxidative substances from blasted neutrophils—play an important role in cancer proliferation, propagation metastasis, and incident CV events (acute coronary syndrome, thromboembolic events, and heart failure). Although NETs have been shown to be involved in cancer progression and incident CV events, little is known about their relationship with cardio-oncology, especially on cancer treatment-related cardiovascular toxicity (CTRCT). This review aims to explore the evidence of the impact of NETs on cancer, CV events, and CTRCT, and the possible solutions based on the mechanism of NETs activation and NETs released toxic substances.
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Affiliation(s)
- Kai-Hung Cheng
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan;
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Gregory P. Contreras
- Auxergen Inc., Columbus Center, 701 East Pratt Street, Baltimore, MD 21202, USA;
| | - Ting-Yu Yeh
- Auxergen Inc., Columbus Center, 701 East Pratt Street, Baltimore, MD 21202, USA;
- Correspondence:
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