Faculty of Medicine

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    Capecitabine-induced Cardiotoxicity Complicated with Acute Coronary Syndrome and Acute Heart Failure: A Case Report and Review of Scientific Data
    (Medicinska Naklada d.o.o., 2025-04)
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    Grueva Nastevska, Elena
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    Shehu, Enes
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    Petkovski, Dushan
    Capecitabine cardiotoxicity is relatively common and may lead to serios cardiovascular complications. The aim of this case report is to emphasize the importance of considering potential toxic effects, rapid therapy discontinuation, and prompt treatment of all complications. We present a case of a 46-yearold male patient who was admitted to our clinic with chest pain and ST segment elevation in the anterior and lateral leads as a sign of acute ST-segment elevation myocardial infarction. Urgent coronary angiography was performed with the finding of a thrombus in the left anterior descendent coronary artery, and percutaneous coronary intervention was subsequently performed. Two months before admission, the patient had undergone surgery for rectal cancer. The above symptoms started three days after the introduction of treatment with capecitabine, which was discontinued on admission. The patient clinically deteriorated during the procedure, with development of cardiogenic shock. An echocardiography exam performed after the procedure showed severe reduction of left ventricular (LV) function (ejection fraction (EF) 21%). Due to further deterioration and cardiogenic shock refractory to optimal inotropic and vasopressor support, veno-arterial extracorporeal membrane oxygenation support was applied and the patient was placed on mechanical ventilation. After all these treatment measures, the patient clinically stabilized. He was extubated after 2 days and hemodynamically stabilized with gradually improvement of LV function. Control echocardiography after 9 days from admission showed an EF of 58%. Our case is an example of successful treatment of the potential serious cardiotoxic complications of capecitabine therapy in a young patient. The case also emphasizes the necessity of multidisciplinary collaboration in similar clinical scenarios.
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    Real-world data of cardiotoxicity during long-term therapy with trastuzumab in human epidermal growth factor receptor-2-positive metastatic breast cancer
    (National Library of Serbia, 2022-12-16)
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    Lazareva, Emilija
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    Introduction/Objective. This study aims to investigate the cardiotoxicity of long-term therapy with trastuzumab in patients with HER2 positive metastatic breast cancer. Methods. A total of 48 patients with metastatic HER2 positive breast cancer were analyzed. The patients received long-term trastuzumab (time of application was longer than 20 months). The analyzed characteristics of the patients were: age, initial stage of the disease, application of anti-HER2 therapy and anthracyclines in the adjuvant setting, the number and type of applied systemic therapies concomitant with trastuzumab in the metastatic setting. Cardiac toxicity was assessed using left ventricular ejection fraction (LVEF) values at three time points: at the beginning, in the middle, and at the end of treatment period for each patient separately. Results. In 17 (35.4%) patients the trastuzumab treatment was temporary discontinued. The average time of trastuzumab therapy interval was 52.2 ? 23.5 months. The mean LVEF values were 66.73 ? 7.02%, 64.62 ? 5.7% and 63.44 ? 6.1%, respectively. The mean values of LVEF differed significantly in the observed three time points (F=4.9 p=0.009). Post hoc pairwise comparison, using Bonferonni correction, confirmed significantly lower mean LVEF values at the end point (at the end of treatment) compared with the mean LVEF values at the beginning of anti-HER2 treatment (p = 0.019), but within the reference range of LVEF ?50%. Conclusion. The data confirm good safety profile of long-term trastuzumab therapy in HER2 positive metastatic breast cancer patients considering cardiotoxicity.