{"id":2070,"date":"2017-10-01T01:00:00","date_gmt":"2017-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/syndrome-dobstruction-sinusoidale-chez-une-patiente-traitee-par-kadcyla-trastuzumab-emtansine\/"},"modified":"2018-10-20T18:40:25","modified_gmt":"2018-10-20T16:40:25","slug":"syndrome-dobstruction-sinusoidale-chez-une-patiente-traitee-par-kadcyla-trastuzumab-emtansine","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/syndrome-dobstruction-sinusoidale-chez-une-patiente-traitee-par-kadcyla-trastuzumab-emtansine\/","title":{"rendered":"Syndrome d\u2019obstruction sinuso\u00efdale chez une patiente trait\u00e9e par KADCYLA \u2013 trastuzumab emtansine"},"content":{"rendered":"

2017<\/strong><\/p>\n

H\u00e9l\u00e8ne JULIEN (1), Anaise BLOUET (2), Derek BARDOU (1), Julie ANTIER (1), Julien BAUDON (1), Mehdi KAASSIS (1).
\n(1) : H\u00e9pato Gastro Ent\u00e9rologie ; (2) : Oncologie m\u00e9dicale, CH CHOLET 49300<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02017-04-29 –\u00a0CC –<\/p>\n

________________________________<\/p>\n

La maladie veine-occlusive ou syndrome d\u2019obstruction sinuso\u00efdale (SOS) est d\u00e9finie par une atteinte des cellules endoth\u00e9liales sinuso\u00efdale puis une obstruction des veines Centro lobulaires. Elle doit \u00eatre diff\u00e9renci\u00e9e des Hyperplasies Hodulaires R\u00e9g\u00e9n\u00e9ratives (HNR) qui font partie du groupe des Maladies Porto Sinuso\u00efdales.
\nDe nombreux m\u00e9dicaments ont \u00e9t\u00e9 incrimin\u00e9s dans ce syndrome SOS notamment l\u2019oxaliplatine ainsi que historiquement la greffe de moelle osseuse.
\nNous rapportons \u00e7\u00e0 notre connaissance le 1er cas de SOS survenu sous chimioth\u00e9rapie par KADCYLA \u00ae (trastuzumab emtansine) pour cancer du sein. Cette pr\u00e9sentation est l\u2019occasion de red\u00e9finir l\u2019entit\u00e9 du SOS, proche de la maladie veino occulsive.<\/p>\n

Cas clinique
\nNous rapportons le cas d\u2019une patiente \u00e2g\u00e9e de 84 ans chez qui est d\u00e9couvert en 2014 un carcinome canalaire infiltrant du sein gauche de grade II HER2 amplifi\u00e9 RE+ RP- en 2014 avec m\u00e9tastases pulmonaires.
\nLes ATCD sont marqu\u00e9s par une cardiopathie isch\u00e9mique avec stent, un diab\u00e8te insulinod\u00e9pendant, des ATCD de cancer du sein chez sa m\u00e8re.
\nLa patiente a \u00e9t\u00e9 trait\u00e9e initialement par chirurgie (mastectomie totale en 2014) puis chimioth\u00e9rapie de 1\u00e8re ligne m\u00e9tastatique par TAXOL et HERCEPTINE hebdomadaire de d\u00e9cembre 2014 \u00e0 mai 2015 puis HERCEPTINE en maintenance de mai 2O15 \u00e0 mars 2016. En Mars 2016, le scanner TAP montre l\u2019apparition de m\u00e9tastases h\u00e9patiques, histologiquement document\u00e9es, sous traitement d\u2019entretien par HERCEPTINE. Devant la progression de la maladie, il est introduit une chimioth\u00e9rapie de 2\u00e8me ligne m\u00e9tastatique KADCYLA. Au bilan interm\u00e9diaire, on retrouve une efficacit\u00e9 de la chimioth\u00e9rapie avec une nette diminution des l\u00e9sions pulmonaires et h\u00e9patiques.
\nApres 8 cures de KADCYLA, la patiente est hospitalis\u00e9e pour h\u00e9mat\u00e9m\u00e8se. La FOGD retrouve des varices \u0153sophagiennes stade II avec du sang frais dans l\u2019estomac, trait\u00e9es par ligatures. La biologie montre une \u00e9l\u00e9vation des GGT \u00e0 4N, ALAT 2N, plaquettes 245 000, TP 72 %.
\nLe scanner abdomino-pelvien retrouve une ascite de faible abondance, une h\u00e9patom\u00e9galie, des signes d\u2019hypertension portale avec voies de d\u00e9rivations p\u00e9ri-ombilicales sans signes de progression h\u00e9patique m\u00e9tastatique, sans thrombose portale.
\nLa ponction biopsie h\u00e9patique retrouve une p\u00e9liose, des sinuso\u00efdes congestif et une fibrose p\u00e9ri-sinuso\u00efdale centrolobulaire s\u2019int\u00e9grant dans le cadre d\u2019un SOS. Une d\u00e9claration de pharmacovigilance \u00e9tait r\u00e9alis\u00e9e.
\nL\u2019Etat g\u00e9n\u00e9ral s\u2019est progressivement d\u00e9grad\u00e9, ne permettant pas la reprise d\u2019une chimioth\u00e9rapie. La patiente est d\u00e9c\u00e9d\u00e9e en d\u00e9cembre 2016.<\/p>\n

Discussion
\nLe SOS est une pathologie de la microcirculation h\u00e9patique retrouvant initialement une atteinte des cellules endoth\u00e9liales sinuso\u00efdales et de l\u2019espace de Disse. Histologiquement, les sinuso\u00efdes apparaissent congestives avec des l\u00e9sions de p\u00e9liose, puis une fibrose centro lobulaire va pouvoir se d\u00e9velopper avec une atteinte des veines centro lobulaires qui vont s\u2019oblit\u00e9rer.
\nLa chimioth\u00e9rapie par KADCYLA compos\u00e9e de trastuzumab emtansine, est indiqu\u00e9e pour le traitement des patientes atteinte de cancer du sein HER2 + m\u00e9tastatique non r\u00e9s\u00e9cable, ayant re\u00e7u une 1\u00e8re ligne de chimioth\u00e9rapie. Le trastuzumab est un anticorps monoclonal humanis\u00e9 contre HER2, r\u00e9cepteur du facteur de croissance humain surexprim\u00e9 dans 20% \u00e0 25% des cancers du sein. L’emtansine est un inhibiteur des microtubules d\u00e9riv\u00e9 de la maytansine.
\nCette chimioth\u00e9rapie est connue pour donner une h\u00e9pato toxicit\u00e9 avec principalement une \u00e9l\u00e9vation des transaminases s\u00e9riques asymptomatiques, notamment l\u2019emtansine peut \u00eatre li\u00e9e \u00e0 une \u00e9l\u00e9vation des enzymes s\u00e9riques ou des \u00e9l\u00e9vations de la bilirubine chez 24% des patients. De plus, des cas de d\u00e9c\u00e8s dus \u00e0 une insuffisance h\u00e9patique, ont \u00e9t\u00e9 signal\u00e9s. Un rapport r\u00e9cent d’hyperplasie r\u00e9g\u00e9n\u00e9rative nodulaire chez 2 femmes atteintes d’un cancer du sein qui ont \u00e9t\u00e9 trait\u00e9es pendant 16 mois avec du trastuzumab emtansine sugg\u00e8re que le traitement peut aussi \u00eatre source de l\u00e9sions vasculaires au foie pouvant conduire \u00e0 la r\u00e9g\u00e9n\u00e9ration nodulaire dans le cadre d\u2019une maladie porto sinusoidale.<\/p>\n

Conclusions
\nUn SOS peut appara\u00eetre sous KADCYL (trastuzumab emtansine). A notre connaissance, nous en rapportons le 1er cas. Il s\u2019agit d\u2019une complication \u00e0 ne pas m\u00e9connaitre du fait d\u2019une symptomatologie clinique plus fruste que dans sa forme historique post allo greffe. Il convient de plus de diff\u00e9rencier le SOS et la maladie veino occlusive, du groupe des Maladies Porto Sinuso\u00efdales dont fait partie l\u2019HNR, et bien une relation entre ces 2 entit\u00e9s soit possible.<\/p>\n","protected":false},"excerpt":{"rendered":"

2017 H\u00e9l\u00e8ne JULIEN (1), Anaise BLOUET (2), Derek BARDOU (1), Julie ANTIER (1), Julien BAUDON (1), Mehdi KAASSIS (1). (1) : H\u00e9pato Gastro Ent\u00e9rologie ; (2) : Oncologie m\u00e9dicale, CH CHOLET 49300 H\u00e9patologie – \u00a02017-04-29 –\u00a0CC – ________________________________ La maladie veine-occlusive ou syndrome d\u2019obstruction sinuso\u00efdale (SOS) est d\u00e9finie par une atteinte des cellules endoth\u00e9liales sinuso\u00efdale […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[28],"class_list":["post-2070","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-28"],"yoast_head":"\nSyndrome d\u2019obstruction sinuso\u00efdale chez une patiente trait\u00e9e par KADCYLA \u2013 trastuzumab emtansine - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/syndrome-dobstruction-sinusoidale-chez-une-patiente-traitee-par-kadcyla-trastuzumab-emtansine\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Syndrome d\u2019obstruction sinuso\u00efdale chez une patiente trait\u00e9e par KADCYLA \u2013 trastuzumab emtansine - 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