Complete atrioventricular block and torsade de pointes due to dose-dense epirubicin and cyclophosphamide therapy
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CASE REPORT
Complete atrioventricular block and torsade de pointes due to dose‑dense epirubicin and cyclophosphamide therapy Taiji Okada1 · Miki Hyakudomi2 · Kazuto Yamaguchi3 · Nobuhide Watanabe3 · Akihiro Endo3 · Hiroyuki Yoshitomi4 · Kazuaki Tanabe3 Received: 31 January 2020 / Accepted: 13 June 2020 © The Japan Society of Clinical Oncology 2020
Abstract The dose-dense epirubicin and cyclophosphamide (EC) therapy for breast cancer decreases the risk of cancer recurrence and death. However, epirubicin and cyclophosphamide also cause cardiotoxicity, and cardiomyopathy is the most well-known related adverse effect. A 58-year-old woman presented to our hospital with palpitations 2 weeks after her final dose-dense EC therapy for breast cancer. Holter electrocardiogram (ECG) showed transitory complete atrioventricular block (CAVB) and torsade de pointes. A 12-lead ECG showed QT prolongation in addition to CAVB. Patients receiving dose-dense EC therapy should be monitored more carefully with ECG due to their risk of fatal arrhythmias. Keywords Dose-dense epirubicin and cyclophosphamide therapy · Breast cancer · QT prolongation · Torsade de pointes · Complete atrioventricular block
Introduction The dose-dense epirubicin and cyclophosphamide (EC) therapy for breast cancer consists of 4 cycles every 2 weeks of 90 mg/m2 of epirubicin and 600 mg/m2 of cyclophosphamide in combination with a subcutaneous injection of pegfilgrastim (3.6 mg). The use of dose-dense EC therapy decreases the risk of cancer recurrence and death [1]. However, epirubicin is an anthracycline drug that causes cardiotoxicity and corrected QT prolongations, and cyclophosphamide is an alkylating agent associated with acute cardiomyopathy [2]. There is no report that case of complete atrioventricular block (CAVB) due to dose-dense EC therapy. * Taiji Okada [email protected]‑u.ac.jp 1
Division of Cardiology, National Hospital Organization Hamada Medical Center, 777‑12 Asaichō, Hamada, Shimane 697‑8511, Japan
2
Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Hamada, Shimane, Japan
3
Division of Cardiology, Shimane University Faculty of Medicine, Hamada, Shimane, Japan
4
Clinical Laboratory Department, Shimane University Faculty of Medicine, Hamada, Shimane, Japan
We herein report the case of a woman with CAVB, QT prolongation, and torsade de pointes (Tdp) due to dosedense EC therapy for breast cancer. She underwent successful arrhythmia treatment and has been able to receive breast cancer treatment.
Case report A 58-year-old woman presented to our hospital with palpitations 2 weeks after her final dose-dense EC chemotherapy administration. She had been diagnosed with right breast cancer with cT3N3M0 stage III c, HER2 type 3 months earlier. She had no history of cardiac disease and had normal chest radiograph (Fig. 1a) and electrocardiography (ECG) findings (Fig. 2a). She had received preoperative chemotherapy with 4 cycles every 2 weeks of intravenous dosedense EC therapy (simultaneous epirubicin 90
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