4-2taxanes-Induced Cardiotoxicity: A Case Report in Breast Cancer Patient With Pre-Existing Hypertension

Abstract

Background: Hypertension is one of the most common comorbidities reported in patients with malignancy. This population had a higher risk of developing cardiotoxicity. Taxanes is an important therapeutic agent for several malignancies, including breast cancers. Their applicability, however, is limited by cardiotoxicity. The optimal strategy to prevent and manage chemotherapy-related cardiotoxicity (CTRCT) has not yet implemented in clinical practices. Case: A 63 years old breast cancer female patient was planned to be treated with Taxanes for six cycles. On admission, there were no cardiovascular symptoms. The patient had a history of hypertension and no history of myocardial infarction or congestive heart failure (CHF). Baseline transthoracic echocardiogram demonstrated normal left ventricular ejection fraction (LVEF) 66%. She received calcium channel blocker for her hypertension during chemotherapy. After the second cycle, the patient experienced palpitation, and there were no other cardiovascular symptoms. Electrocardiogram showed Left Bundle Branch Block. Echocardiogram revealed LVEF 46% with anteroseptal and inferoseptal hypokinetic. She was suspected as CHF chemotherapy-induced. Taxane was stopped, and she was treated with angiotensin receptor blocker, beta-blocker, and loop diuretic. Two months after therapy, her LVEF revealed partial recovery with LVEF 60% and no reported symptoms. Conclusion: Prophylactic agents targeting pre-existing cardiac risk factor has not been implemented in clinical practice but may soon change. Early detection and prompt management appear crucial to reverse left ventricular dysfunction in cancer patients receiving taxanes, especially in patients with pre-existing hypertension.