Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Jul 27;14(7):e243946.
doi: 10.1136/bcr-2021-243946.

Entrectinib-related myocarditis in a young female patient with metastatic non-small cell lung cancer

Marta Fonseca  1   2 , Daniel H Chen  3   2 , John Malcolm Walker  2 , Arjun K Ghosh  3   2
Affiliations
Case Reports

Entrectinib-related myocarditis in a young female patient with metastatic non-small cell lung cancer

Marta Fonseca et al. BMJ Case Rep. .

Abstract

A 51-year-old woman presented with a 2-week history of off balance, left lower limb weakness and neglect and neck pain radiating down the right arm. Investigations revealed a metastatic, ROS1 fusion-positive, non-small cell lung cancer, and treatment with entrectinib, a recently approved multikinase inhibitor, was started. Two weeks after, she was admitted to the emergency department with new-onset pressure-like chest pain and dyspnoea. Laboratory evaluation showed elevated troponin and mild left ventricular systolic dysfunction with reduced global longitudinal strain on transthoracic echocardiogram. Cardiac magnetic resonance revealed mild oedema and non-ischaemic fibrosis. A diagnosis of drug-induced myocarditis was made. Cardioprotective medication with an angiotensin-converting enzyme inhibitor and a beta-blocker was started. Entrectinib was temporarily discontinued and restarted at a reduced dose after a multidisciplinary team meeting involving both the oncology and cardio-oncology teams. This is the second described case of entrectinib-induced myocarditis and the first one without eosinophilia.

Keywords: cancer - see oncology; cardiovascular medicine; chemotherapy; lung cancer (oncology); unwanted effects / adverse reactions.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
12-lead ECG.
Figure 2
Figure 2
Chest X-ray showing a right parahilar opacity and a small left pleural effusion.
Figure 3
Figure 3
Speckle tracking imaging from transthoracic echocardiography showing reduced longitudinal strain.
Figure 4
Figure 4
Cardiac magnetic resonance parametric mapping showing mildly elevated T2 values.
Figure 5
Figure 5
Inversion recovery cardiac MRI showing late gadolinium enhancement on the basal inferolateral segment.
See this image and copyright information in PMC

References

    1. Drilon A, Siena S, Dziadziuszko R, et al. Entrectinib in ROS1 fusion-positive non-small-cell lung cancer: integrated analysis of three phase 1-2 trials. Lancet Oncol 2020;21:261–70. 10.1016/S1470-2045(19)30690-4 - DOI - PMC - PubMed
    1. Entrectinib for treating ROS1-positive advanced non- small-cell lung cancer, 2020. Available: https://www.nice.org.uk/guidance/ta643 [Accessed 20 Mar 2021].
    1. Dziadziuszko R, Krebs MG, De Braud F. Updated integrated analysis of the efficacy and safety of Entrectinib in locally advanced or metastatic ROS1 Fusion–Positive Non–Small-Cell lung cancer. J Clin Oncol. - PMC - PubMed
    1. ROZLYTREK FDA package insert, 2019. Available: http://www.fda.gov/CompanionDiagnostics%0Ahttp://www.accessdata.fda.gov/... [Accessed 21 Feb 2021].
    1. Dominguez F, Kühl U, Pieske B, et al. Actualización sobre miocarditis y miocardiopatía inflamatoria: el resurgir de la biopsia endomiocárdica. Rev Española Cardiol 2016;69:178–87. 10.1016/j.recesp.2015.10.018 - DOI

Publication types