Severe reversible cardiac failure after bortezomib treatment combined with chemotherapy in a non-small cell lung cancer patient: a case report

Jens Voortman, Giuseppe Giaccone

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Bortezomib (Velcade), a dipeptide boronate proteasome inhibitor, is a novel anti-cancer agent registered for multiple myeloma (MM). It has also shown promising clinical activity in non-small cell lung cancer (NSCLC). Clinical experience with bortezomib so far indicates that overall incidence of cardiac failure associated with bortezomib therapy remains incidental. Nevertheless, acute development or exacerbation of congestive cardiac failure has been associated with bortezomib treatment.

CASE PRESENTATION: We present here a case of severe, but reversible, congestive cardiac failure in a lung cancer patient who had no prior cardiac history, after receiving an experimental treatment of bortezomib combined with chemotherapy. Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), as retrospectively measured in archived serum samples, were suggestive of pre-existent (sub-clinical) left ventricular dysfunction.

CONCLUSION: Based on literature, we hypothesize that baseline presence of sub clinical cardiomyopathy, characterized by a dysregulation of the ubiquitin-proteasome system, could have predisposed this patient for a cardiac side effect induced by systemic proteasome inhibition. Patients with heart disease or risk factors for it should be closely monitored when being submitted to treatment with proteasome inhibition therapy such as bortezomib. Caution is therefore warranted in lung cancer patients who often present with cardiac comorbidities.

Original languageEnglish
Pages (from-to)129
JournalBMC Cancer
Volume6
DOIs
Publication statusPublished - 11 May 2006

Cite this

@article{aceb39cdaba7457599f92d3028ae21cf,
title = "Severe reversible cardiac failure after bortezomib treatment combined with chemotherapy in a non-small cell lung cancer patient: a case report",
abstract = "BACKGROUND: Bortezomib (Velcade), a dipeptide boronate proteasome inhibitor, is a novel anti-cancer agent registered for multiple myeloma (MM). It has also shown promising clinical activity in non-small cell lung cancer (NSCLC). Clinical experience with bortezomib so far indicates that overall incidence of cardiac failure associated with bortezomib therapy remains incidental. Nevertheless, acute development or exacerbation of congestive cardiac failure has been associated with bortezomib treatment.CASE PRESENTATION: We present here a case of severe, but reversible, congestive cardiac failure in a lung cancer patient who had no prior cardiac history, after receiving an experimental treatment of bortezomib combined with chemotherapy. Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), as retrospectively measured in archived serum samples, were suggestive of pre-existent (sub-clinical) left ventricular dysfunction.CONCLUSION: Based on literature, we hypothesize that baseline presence of sub clinical cardiomyopathy, characterized by a dysregulation of the ubiquitin-proteasome system, could have predisposed this patient for a cardiac side effect induced by systemic proteasome inhibition. Patients with heart disease or risk factors for it should be closely monitored when being submitted to treatment with proteasome inhibition therapy such as bortezomib. Caution is therefore warranted in lung cancer patients who often present with cardiac comorbidities.",
keywords = "Antineoplastic Agents/adverse effects, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Boronic Acids/adverse effects, Bortezomib, Carcinoma, Non-Small-Cell Lung/drug therapy, Cisplatin/administration & dosage, Comorbidity, Deoxycytidine/administration & dosage, Heart Failure/chemically induced, Humans, Lung Neoplasms/drug therapy, Male, Middle Aged, Pyrazines/adverse effects, Risk Factors, Ventricular Dysfunction, Left/complications",
author = "Jens Voortman and Giuseppe Giaccone",
year = "2006",
month = "5",
day = "11",
doi = "10.1186/1471-2407-6-129",
language = "English",
volume = "6",
pages = "129",
journal = "BMC Cancer",
issn = "1471-2407",
publisher = "BioMed Central",

}

Severe reversible cardiac failure after bortezomib treatment combined with chemotherapy in a non-small cell lung cancer patient : a case report. / Voortman, Jens; Giaccone, Giuseppe.

In: BMC Cancer, Vol. 6, 11.05.2006, p. 129.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Severe reversible cardiac failure after bortezomib treatment combined with chemotherapy in a non-small cell lung cancer patient

T2 - a case report

AU - Voortman, Jens

AU - Giaccone, Giuseppe

PY - 2006/5/11

Y1 - 2006/5/11

N2 - BACKGROUND: Bortezomib (Velcade), a dipeptide boronate proteasome inhibitor, is a novel anti-cancer agent registered for multiple myeloma (MM). It has also shown promising clinical activity in non-small cell lung cancer (NSCLC). Clinical experience with bortezomib so far indicates that overall incidence of cardiac failure associated with bortezomib therapy remains incidental. Nevertheless, acute development or exacerbation of congestive cardiac failure has been associated with bortezomib treatment.CASE PRESENTATION: We present here a case of severe, but reversible, congestive cardiac failure in a lung cancer patient who had no prior cardiac history, after receiving an experimental treatment of bortezomib combined with chemotherapy. Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), as retrospectively measured in archived serum samples, were suggestive of pre-existent (sub-clinical) left ventricular dysfunction.CONCLUSION: Based on literature, we hypothesize that baseline presence of sub clinical cardiomyopathy, characterized by a dysregulation of the ubiquitin-proteasome system, could have predisposed this patient for a cardiac side effect induced by systemic proteasome inhibition. Patients with heart disease or risk factors for it should be closely monitored when being submitted to treatment with proteasome inhibition therapy such as bortezomib. Caution is therefore warranted in lung cancer patients who often present with cardiac comorbidities.

AB - BACKGROUND: Bortezomib (Velcade), a dipeptide boronate proteasome inhibitor, is a novel anti-cancer agent registered for multiple myeloma (MM). It has also shown promising clinical activity in non-small cell lung cancer (NSCLC). Clinical experience with bortezomib so far indicates that overall incidence of cardiac failure associated with bortezomib therapy remains incidental. Nevertheless, acute development or exacerbation of congestive cardiac failure has been associated with bortezomib treatment.CASE PRESENTATION: We present here a case of severe, but reversible, congestive cardiac failure in a lung cancer patient who had no prior cardiac history, after receiving an experimental treatment of bortezomib combined with chemotherapy. Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), as retrospectively measured in archived serum samples, were suggestive of pre-existent (sub-clinical) left ventricular dysfunction.CONCLUSION: Based on literature, we hypothesize that baseline presence of sub clinical cardiomyopathy, characterized by a dysregulation of the ubiquitin-proteasome system, could have predisposed this patient for a cardiac side effect induced by systemic proteasome inhibition. Patients with heart disease or risk factors for it should be closely monitored when being submitted to treatment with proteasome inhibition therapy such as bortezomib. Caution is therefore warranted in lung cancer patients who often present with cardiac comorbidities.

KW - Antineoplastic Agents/adverse effects

KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use

KW - Boronic Acids/adverse effects

KW - Bortezomib

KW - Carcinoma, Non-Small-Cell Lung/drug therapy

KW - Cisplatin/administration & dosage

KW - Comorbidity

KW - Deoxycytidine/administration & dosage

KW - Heart Failure/chemically induced

KW - Humans

KW - Lung Neoplasms/drug therapy

KW - Male

KW - Middle Aged

KW - Pyrazines/adverse effects

KW - Risk Factors

KW - Ventricular Dysfunction, Left/complications

U2 - 10.1186/1471-2407-6-129

DO - 10.1186/1471-2407-6-129

M3 - Article

VL - 6

SP - 129

JO - BMC Cancer

JF - BMC Cancer

SN - 1471-2407

ER -