Symptomatic Coronary Artery Diseases in Association with Thalidomide Therapy

心臟症狀性冠狀動脈疾患與沙利竇邁(Thalidomide)治療之關聯性

林育佳(Yu-Chia Lin) ； 蔡文展(Wen-Chan Tsai) ； 顏學偉(Hsueh-Wei Yen) ； 陳立宗(Li-Tzong Chen)

《中華民國癌症醫學會雜誌》 22卷2期 (2006/06) Pp. 36-49

https://doi.org/10.6588/JCOS.2006.22.2.2

摘要

沙利竇邁(Thalidomide)在癌症治療上扮演著調節免疫以及抑制血管新生等角色，尤其使用在荷爾蒙抗性(hormone-refractory)攝護腺癌，高惡性度神經膠質瘤(high-grade glioma)，腎細胞癌，乳癌，卡波西氏瘤(Kaposi's sarcoma)，多發性骨髓瘤，以及骨髓造血不良症候群(myelodysplastic syndrome)。在這篇文章中，我們描述兩位接受沙利竇邁治療的病患，在接受治療期間出現冠心症(coronary artery disease)的症狀，這兩位病患中，一位是僵直性脊椎炎，另一位是荷爾蒙抗性攝護腺癌。這兩位病患都沒有心臟病的病史，而且在接受沙利竇邁100 mg一天兩次的治療之後兩個月出現冠心症的症狀。兩位病患的休息以及運動心電圖均顯示有顯著的缺血變化。其中一位病患甚至有嚴重的三條冠狀動脈疾患(3-vessels coronary artery disease)。另一位病患雖然冠狀動脈攝影正常，但鉈201(201 Thallium)心肌灌流攝影則出現異常的情形。這篇報告提醒我們，必須精細地選擇接受沙利竇邁治療的病患，並仔細評估病患在接受治療時是否出現心臟方面的症狀，以調整治療的方向。

並列摘要

Thalidomide is known as an immunomodulator and an angiogenesis inhibitor in cancer therapy, notably hormone-refractory prostate cancer, high-grade glioma, renal cell carcinoma, breast cancer, Kaposi's sarcoma, multiple myeloma, and myelodysplastic syndrome. In this report, we describe two patients who developed symptomatic coronary artery events while receiving thalidomide for ankylosing spondylitis and hormone-refractory prostate cancer. Both patients had no prior history of cardiac diseases and developed symptomatic cardiac events after 2 months of thalidomide (100 mg twice daily) therapy. Resting and exercise electrocardiograms of both patients showed significant ischemic changes. One patient was subsequently found to have severe 3-vessels coronary artery disease (CAD). The other patient had abnormal stress 201 thallium cardiac single photon emission tomography (SPECT) with a normal coronary arteriography. Our observation highlights the importance of meticulous patient selection for thalidomide therapy, and the necessity of careful evaluation for coronary artery diseases in patients with newly developed cardiac symptoms while receiving thalidomide therapy.

並列關鍵字

Myocardial Ischemia ； Thalidomide