Reactions 1460, p42 - 13 Jul 2013

SVandetanib

Cardiomyopathy leading to fatal acute cardiacfailure: case report

A man in his forties developed cardiomyopathy, leading tofatal acute cardiac failure, during therapy with vandetanib formetastatic medullary thyroid carcinoma.

A month after starting vandetanib 300mg daily [route notstated], the man developed a severe (grade 3) skin rash, forwhich he received antihistamines and glucocorticoids. Hisvandetanib dosage was reduced to 200mg daily, but his rashdid not improve, and vandetanib was withdrawn. Vandetanibwas restarted at 100mg daily. During treatment, he developedasymptomatic atrioventricular nodal reentrant tachycardia,which was controlled with propranolol; no signs of congestiveheart failure were observed. Fourteen months after startingtherapy, he was admitted with dyspnoea and thoracic pain.Investigations revealed hypoxaemia and metabolic acidosis.Thirty-six hours after admission, he experienced a cardiacarrest with pulseless ventricular tachycardia.

The man received cardiopulmonary resuscitation.Electrocardiograms revealed left ventricular

dysfunction, a dilated left ventricle, and mild dilation of hisleft atrium. Pulmonary artery catheterisation showed that theshock had a cardiogenic aetiology. He receivednorepinephrine [noradrenaline], dobutamine, antibiotics,hydrocortisone and mechanical ventilation but, 7 days afterbeing admitted, he died of irreversible ventricular tachycardia.Postmortem investigations indicated that drug-inducedcardiotoxicity had occurred.

Author comment: The authors report the case of a patient"who developed acute fatal cardiac failure during vandetanibtherapy. Postmortem examination of the heart revealedpathological changes suggestive of drug-inducedcardiotoxicity."Scheffel RS, et al. Toxic cardiomyopathy leading to fatal acute cardiac failurerelated to vandetanib: a case report with histopathological analysis. EuropeanJournal of Endocrinology 168: K51-4, No. 6, Jun 2013. Available from: URL:http://dx.doi.org/10.1530/EJE-13-0015 - Brazil 803089878

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Reactions 13 Jul 2013 No. 14600114-9954/13/1460-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved