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Cytokine storm complicated by cardiogenic shock induced by anti-HER2 therapies

Cytokine storm induced by anti-human epidermal growth factor receptor-2 (HER2) therapies has not been reported. We report a patient with breast cancer treated with trastuzumab/pertuzumab who developed severe biventricular dysfunction and cardiogenic shock (CS) 6 months after starting double anti-HER...

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Autores principales: Godinho, Rita, Noto, Alessandra, Fenwick, Craig, Stravodimou, Athina, Hugelshofer, Sarah, Peters, Solange, Hullin, Roger, Obeid, Michel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410976/
https://www.ncbi.nlm.nih.gov/pubmed/37380369
http://dx.doi.org/10.1136/jitc-2023-006942
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author Godinho, Rita
Noto, Alessandra
Fenwick, Craig
Stravodimou, Athina
Hugelshofer, Sarah
Peters, Solange
Hullin, Roger
Obeid, Michel
author_facet Godinho, Rita
Noto, Alessandra
Fenwick, Craig
Stravodimou, Athina
Hugelshofer, Sarah
Peters, Solange
Hullin, Roger
Obeid, Michel
author_sort Godinho, Rita
collection PubMed
description Cytokine storm induced by anti-human epidermal growth factor receptor-2 (HER2) therapies has not been reported. We report a patient with breast cancer treated with trastuzumab/pertuzumab who developed severe biventricular dysfunction and cardiogenic shock (CS) 6 months after starting double anti-HER2 therapy. The CS was accompanied by severe systemic inflammation, and cardiac MRI (cMRI) showed structural changes typical of myocardial inflammation. The immuno-inflammatory profile showed significantly increased levels of activation of the complement system, proinflammatory cytokines (IL-1β, IL-6, IL-18, IL-17A, TNF-alpha) with increased activity of classical monocytic, T helper 17 cells (Th17), CD4 T and effector memory CD8 T subsets, whereas NK cell activation was not observed. The data suggest an important role for monocytes as initiators of this FcγR-dependent antibody-dependent cytotoxicity, leading to the overactivation of an adaptive T cell response, in which Th17 cells may act in synergy with T helper 1 cells (Th1) to drive the severe cytokine release syndrome. After discontinuation of trastuzumab/pertuzumab, hypercytokinemia and complement activity normalized along with clinical recovery. Cardiac function returned to baseline within 2 months of initial presentation, together with a resolution of the myocardial inflammation on MRI.
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spelling pubmed-104109762023-08-10 Cytokine storm complicated by cardiogenic shock induced by anti-HER2 therapies Godinho, Rita Noto, Alessandra Fenwick, Craig Stravodimou, Athina Hugelshofer, Sarah Peters, Solange Hullin, Roger Obeid, Michel J Immunother Cancer Case Report Cytokine storm induced by anti-human epidermal growth factor receptor-2 (HER2) therapies has not been reported. We report a patient with breast cancer treated with trastuzumab/pertuzumab who developed severe biventricular dysfunction and cardiogenic shock (CS) 6 months after starting double anti-HER2 therapy. The CS was accompanied by severe systemic inflammation, and cardiac MRI (cMRI) showed structural changes typical of myocardial inflammation. The immuno-inflammatory profile showed significantly increased levels of activation of the complement system, proinflammatory cytokines (IL-1β, IL-6, IL-18, IL-17A, TNF-alpha) with increased activity of classical monocytic, T helper 17 cells (Th17), CD4 T and effector memory CD8 T subsets, whereas NK cell activation was not observed. The data suggest an important role for monocytes as initiators of this FcγR-dependent antibody-dependent cytotoxicity, leading to the overactivation of an adaptive T cell response, in which Th17 cells may act in synergy with T helper 1 cells (Th1) to drive the severe cytokine release syndrome. After discontinuation of trastuzumab/pertuzumab, hypercytokinemia and complement activity normalized along with clinical recovery. Cardiac function returned to baseline within 2 months of initial presentation, together with a resolution of the myocardial inflammation on MRI. BMJ Publishing Group 2023-06-28 /pmc/articles/PMC10410976/ /pubmed/37380369 http://dx.doi.org/10.1136/jitc-2023-006942 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Case Report
Godinho, Rita
Noto, Alessandra
Fenwick, Craig
Stravodimou, Athina
Hugelshofer, Sarah
Peters, Solange
Hullin, Roger
Obeid, Michel
Cytokine storm complicated by cardiogenic shock induced by anti-HER2 therapies
title Cytokine storm complicated by cardiogenic shock induced by anti-HER2 therapies
title_full Cytokine storm complicated by cardiogenic shock induced by anti-HER2 therapies
title_fullStr Cytokine storm complicated by cardiogenic shock induced by anti-HER2 therapies
title_full_unstemmed Cytokine storm complicated by cardiogenic shock induced by anti-HER2 therapies
title_short Cytokine storm complicated by cardiogenic shock induced by anti-HER2 therapies
title_sort cytokine storm complicated by cardiogenic shock induced by anti-her2 therapies
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410976/
https://www.ncbi.nlm.nih.gov/pubmed/37380369
http://dx.doi.org/10.1136/jitc-2023-006942
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