Gemcitabine-induced cardiomyopathy: a case report and review of the literature

Abstract

IntroductionNewly developed antineoplastic drugs have resulted in improvements in morbidity and mortality from many forms of cancers. However, some of these new chemotherapeutic agents have potentially lethal side effects, which are now being exposed with their widespread use. Gemcitabine is a nucleoside analog, which is a commonly used agent for various solid organ malignancies. Phase 1 and 2 trials with gemcitabine did not show significant risk for cardiotoxicity; however, with its widespread clinical use over the last decade, a few cases of cardiotoxicity related to gemcitabine use have been reported. Cardiomyopathy after the use of gemcitabine monotherapy is extremely rare; and only one such case has been reported in detail previously.Case presentationWe report a case of a 56-year-old African American man with pancreatic cancer who presented with signs and symptoms of congestive heart failure after being treated with gemcitabine for two cycles (six doses). A two-dimensional echocardiography showed left ventricular ejection fraction of 15 to 20 percent with global hypokinesia. With the absence of significant risk factors for coronary artery disease and a strong temporal relationship with the initiation of chemotherapy, it was concluded that our patient’s cardiomyopathy was related to the use of gemcitabine. Gemcitabine was discontinued and our patient responded well to standard heart failure therapy. Two months later, a repeat echocardiogram showed significant improvements in left ventricular systolic function.ConclusionsGemcitabine should be considered as a potential cause of cardiomyopathy in patients receiving chemotherapy with this drug. We need further studies to look into potential mechanisms and treatments of gemcitabine-induced cardiac dysfunction.

Gemcitabine induced cardiomyopathy: a case of multiple hit cardiotoxicity

“…In these trials, patients who developed cardiomyopathies had underlying coronary artery disease, whereas our patient had no history of coronary disease. Outside of clinical trials, gemcitabine‐induced cardiomyopathy has been reported only once in the literature 2. The patient described was similar to ours.…”

“…Outside of clinical trials, gemcitabine-induced cardiomyopathy has been reported only once in the literature. 2 The patient described was similar to ours. He did not have prior coronary artery disease or risk factors.…”

“…1 It is most commonly used in solid organ malignancies such as non-small cell lung cancer, and breast, ovarian, and pancreatic cancer, although is also used in diffuse large B-cell lymphoma in relapsed or refractory elderly patients. 2 It has rare cardiac side effects including acute myocardial infarction, but is not well known to cause cardiomyopathy.…”

Synthesis of 2-Substituted Benzothiazole Derivatives and Their In Vitro Anticancer Effects and Antioxidant Activities Against Pancreatic Cancer Cells

“…Our previous study showed that benzothiazole compounds dose-dependently inhibit the proliferation of C6 (rat brain tumor) and HeLa (human uterine cancer) cell lines (25). Gemcitabine is generally used in therapy of pancreatic, bladder, breast, ovarian and non-small cell lung (26)(27)(28)(29)(30) cancer. Both compounds 4a and 4b demonstrated potent cytotoxicity towards PANC-1 cells, with IC 50 of 27±0.24 μM and 35±0.51 μM, respectively.…”

From Molecular Mechanisms to Clinical Management of Antineoplastic Drug-Induced Cardiovascular Toxicity: A Translational Overview

“…5-FU reaches higher levels in cancer cells than in systemic circulation when administered intravenously. One 5-FU pro-drug is capecitabine, which is converted into its active form after oral administration (11,188,191,253,278,302). start of the first cycle of chemotherapy (174,175).…”