培唑帕尼致严重心功能不全1例

A case of severe cardiac insufficiency induced by pazopanib

1例63岁男性患者,因“转移性透明细胞型肾细胞癌”给予培唑帕尼片(800 mg,qd)一线治疗,培唑帕尼启动前患者左室射血分数(LVEF)为59%,服药后第35天出现活动后气短症状,LVEF 55%,纽约心脏病协会(NYHA)心功能分级为Ⅱ级,给予沙库巴曲缬沙坦钠片(50 mg,bid)治疗后症状好转。因严重腹泻暂停培唑帕尼治疗,腹泻好转后将培唑帕尼剂量调整为600 mg,qd继续服用,5 d后患者再次出现喘憋,LVEF 35%~45%,NYHA心功能Ⅳ级,予停药并给予沙库巴曲缬沙坦钠片(50 mg,bid)、阿替洛尔片(12.5 mg,bid)、螺内酯片(20 mg,qd)、地高辛片(0.13 mg,qd)、呋塞米片(20 mg,qd)联合治疗后好转,LVEF 65%,患者后续未再使用培唑帕尼治疗。

A 63-year-old male patient was given pazopanib tablets(800 mg,qd)for the first-line treatment of metastatic clear cell renal cell carcinoma.The left ventricular ejection fraction(LVEF)before initiation of pazopanib was 59%.After 35 days,he developed shortness of breath after exercise with the LVEF of 55%and the New York Heart Association(NYHA)class wasⅡ,which was improved after using sacubitril valsartan sodium tablets(50 mg,bid).And then pazopanib was stopped due to severe diarrhea.After the diarrhea improved,pazopanib was given to him again at the dose of 600 mg,qd.But he developed wheezing with LVEF of 35%–45%and NYHA class asⅣ5 days later.Pazopanib was immediately stopped again,and sacubitril valsartan sodium tablets(50 mg,bid),atenolol tablets(12.5 mg,bid),spironolactone tablets(20 mg,qd),digoxin tablets(0.13 mg,qd),furosemide tablets(20 mg,qd)were given to him.The symptoms improved and the LVEF increased to 65%.The patient has never used pazopanib since then.