Unclassified Pleomorphic and Spindle Cell Pulmonary Neoplasm with Brain Metastases after PrasugrelSerebruany V.L. · DiNicolantonio J.J. · Can M.M. · Goto S.
HeartDrug™ Research Laboratories, Johns Hopkins University, Towson, Md., USA
Background: There was an excess of new solid neoplasms (112 vs. 69), and cancer deaths (24 vs. 15) after prasugrel in the TRITON (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition). These cancers usually occur after 4 months following prasugrel, and women are especially at risk. The hypothesis has been offered that prasugrel, but not aspirin or clopidogrel, causes indirect modulation of tumor growth, and/or enhanced metastatic dissemination due to instability of platelet-tumor cell aggregates via the inability to keep cancer locally within the platelet thrombi due to excessive chronic platelet inhibition. Case Report: A 70-year old female diabetic patient underwent drug-eluting stent implantation. The patient received a loading dose of prasugrel (60 mg), followed by prasugrel 10 mg/daily as well as aspirin (81 mg/daily). After 4 months on dual antiplatelet therapy she expectorated blood when coughing. A lung X-ray and CT scan revealed numerous lung nodules later diagnosed as unclassified pleomorphic and spindle cell malignant solid neoplasm. The patient died following multiple brain metastasis. Conclusion: Female gender, duration of prasugrel exposure, rare unclassified neoplasm pathology type and a tumor of a highly metastatic and aggressive nature in the index patient should be regarded with caution. The effects of novel antiplatelet agents on the onset of cancer should be tested in future mega-trials.
© 2013 S. Karger AG, Basel
Received: November 22, 2012
Accepted after revision: November 30, 2012
Published online: January 30, 2013
Number of Print Pages : 6
Number of Figures : 3, Number of Tables : 2, Number of References : 17
Cardiology (International Journal of Cardiovascular Medicine, Surgery, Pathology and Pharmacology)
Vol. 124, No. 2, Year 2013 (Cover Date: March 2013)
Journal Editor: Borer J.S. (New York, N.Y.)
ISSN: 0008-6312 (Print), eISSN: 1421-9751 (Online)
For additional information: http://www.karger.com/CRD