Oxaliplatin-induced coronary artery spasm: first report of an important side-effect

Samol, Jens; Waterston, Ashita

doi:10.1136/bcr.06.2008.0334

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…To the best of our knowledge, this is a rare diagnosis in the literature, with only 2 case reports of colorectal cancer. The first case was reported by Jens Samol et al [ 13 ] who clarified that it was a coronary spasm and the second was reported by Stefano Coli et al [ 14 ], confirming Takotsubo syndrome.…”

Section: Discussionmentioning

confidence: 99%

Oxaliplatin-Associated Takotsubo Cardiomyopathy in a Patient with Metastatic Gastric Cancer: A Case Report

Osorio-Toro,

Bonilla-Bonilla,

Escobar-Dávila

et al. 2023

Case Rep Oncol

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We present the case of a 64-year-old female with stage IV gastric adenocarcinoma, pulmonary, and abdominal wall metastases, and no history of cardiovascular disease. In palliative care, she received systemic cytotoxic treatment with fluorouracil, leucovorin, oxaliplatin, and docetaxel protocol, which was well tolerated over five cycles. During cycle 6, she presented with cardiovascular symptoms with hemodynamic consequences while receiving oxaliplatin injection without docetaxel or 5-fluorouracil. She was transferred to the emergency department and then to the intensive care unit. She developed no complications during the hospital stay and was discharged after 10 days with preserved systolic function and no structural changes at the myocardial level. The electrocardiogram, echocardiogram, cardiac catheterization, and magnetic resonance imaging findings indicated an oxaliplatin-associated Takotsubo syndrome. The immunochemistry analysis showed PD-L1 expression level TPS: 40% and the foundation one genomic profiling revealed high mutation load, microsatellite instability, and HER2 not found. The patient is currently asymptomatic and on pembrolizumab monotherapy with good tolerance and partial treatment response.

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Section: Discussionmentioning

confidence: 99%

Oxaliplatin-Associated Takotsubo Cardiomyopathy in a Patient with Metastatic Gastric Cancer: A Case Report

Osorio-Toro,

Bonilla-Bonilla,

Escobar-Dávila

et al. 2023

Case Rep Oncol

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“…We found a total of three cases of oxaliplatin-induced coronary spasms. One patient with colorectal cancer metastasizing to the liver received an oxaliplatin infusion (170 mg) and developed T inversion of lead I, II, aVF, and V3 to V6 on the ECG ( 10 ). His coronary angiogram was unremarkable.…”

Section: Discussionmentioning

confidence: 99%

“…A possible pathophysiology of oxaliplatin-induced coronary spasms may be through hyperexcitable voltage-gated Na+ channels ( 10 , 13 ); another may be via inflammatory mediators such as histamine or leukotriene released during allergic injury, triggered by oxaliplatin-induced degranulation of mast cells and basophils after IgE binding ( 14 – 16 ). One article depicted a case of oxaliplatin-induced type 1 Kounis syndrome ( 11 ), a simultaneous occurrence of acute coronary events and hypersensitivity allergic reactions, manifesting as coronary artery spasms.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Oxaliplatin-Induced Third-Degree Atrioventricular Block: First Discovery of an Important Side-Effect

Chen

Wang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe adverse effects of anticancer therapy in patients with malignancies and cardiovascular diseases are complicated. Oxaliplatin is one of the most commonly used chemotherapy drugs for gastric and colorectal cancers, and oxaliplatin-induced cardiotoxicity has rarely been reported.Case SummaryWe report a 76-year-old man with adenocarcinoma of the esophagogastric junction and a 40-day history of non-ST-elevation myocardial infarction who exhibited a new third-degree atrioventricular block after oxaliplatin administration. We immediately withdrew oxaliplatin treatment and, to avoid future episodes, we implanted a permanent pacemaker for safety and added diltiazem hydrochloride. The third-degree atrioventricular block disappeared after oxaliplatin withdrawal. We detected no recurrence of the third-degree atrioventricular block in future chemotherapies.ConclusionsThis is the first reported oxaliplatin-induced third-degree atrioventricular block, likely mediated by coronary artery spasm. Cancer patients with acute coronary syndrome are a unique and vulnerable population, whom physicians should carefully evaluate and monitor during anticancer treatment. Remarkably, even the most common chemotherapy drugs can cause life-threatening cardiac adverse events.

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“…24 Samol et al have previously published a case report where oxaliplatin caused coronary artery spasms and speculated that this may have been due to voltage-gated Na+ channels. 25 There have been two reports thus far of suspected oxaliplatin-induced LQTS in patients with lower gastrointestinal (GI) cancers. 26,27 Anti-emetics, such as domperidone, are commonly prescribed to patients on chemotherapy to treat nausea.…”

Section: Hereditary Non-polyposis Colorectal Cancermentioning

confidence: 99%

Lynch Syndrome and Long QT Syndrome – As If One Syndrome is Not Already Enough

Lim¹,

Newell²,

Ezzat³

et al. 2014

European Oncology &Amp; Haematology

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A 51-year-old patient was treated with chemotherapy for two synchronous colon cancers and was diagnosed with Lynch syndrome. The patient also suffered a cardiac arrest and was also diagnosed with a long QT syndrome (LQTS) subsequently. This is the first case of a co-existence of Lynch syndrome and LQTS. Keywords Case HistoryA 51-year-old male presented with a change in his bowel habit and was shown to have iron deficiency anaemia without blood in his stool.There was no family history of cancer, he was not on any medications and had no allergies. Of note was a history of faints. An initial diagnosis of irritable bowel syndrome (IBS) was made and iron supplementation was prescribed. However with no improvement in symptoms, the patient was referred to gastroenterology for colonoscopy and the descending colon biopsy showed an adenocarcinoma. A pre-surgical electrocardiogram (ECG) was normal with a corrected QT (QTc) of 385 (see Figure 1). He underwent a subtotal colectomy and a diagnosis of two synchronous Dukes' stage C (caecum and descending colon) cancers was made. Immunohistochemical (IHC) stains demonstrated a loss of staining for MLH1 and PMS2 in both cancers (see Figures 2a and 2b). Subsequent genetic testing has shown him to be a MLH1 mutation carrier. Following his surgery, the patient received four cycles of adjuvant chemotherapy with oral capecitabine (1,000 mg/m 2 ) and intravenous oxaliplatin (130 mg/m 2 ), called XELOX. XELOX-chemotherapy is delivered as a 3-weekly cycle with oxaliplatin administered on the first day of each cycle and oral capecitabine is taken twice daily for 2 weeks.Our patient tolerated XELOX-chemotherapy well and had no dose reductions. While taking capecitabine tablets as part of the fourth cycle, he unfortunately suffered a cardiac arrest in a public place, but was successfully resuscitated on site. Subsequent cardiac investigations including an adrenaline stress test using the Mayo protocol 1 have led to the diagnosis of LQTS (see Figures 3a and b). Genetic analysis of the most commonly implicated genes, LQT genes 1-5, was negative but this does not exclude the presence of a less common LQT syndrome. One of our patient's children was also found to have a positive adrenaline stress test and has been started on β-blockers. This strengthens the likelihood of an underlying genetic cause for the LQT syndrome. It was thought that the chemotherapy tablet capecitabine and/or the metic domperidome, given over 5 days at the beginning of each cycle at a dose of 20 mg three times per day, led to an unmasking of the thus far undiagnosed LQTS. Subsequently an implantable cardioverterdefibrillator was inserted and adjuvant chemotherapy was stopped.He has undergone genetic counselling for the inherited disorders and continued to attend oncological follow-up. He is now 2 years post the cardiac arrest, clinically well with a performance status of 0, and has no evidence of a cancer associated with HNPCC. Hereditary Non-polyposis Colorectal CancerHNPCC, also known as Lynch syndrome, is a...

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Oxaliplatin-induced coronary artery spasm: first report of an important side-effect

Cited by 6 publications

References 16 publications

Oxaliplatin-Associated Takotsubo Cardiomyopathy in a Patient with Metastatic Gastric Cancer: A Case Report

Oxaliplatin-Associated Takotsubo Cardiomyopathy in a Patient with Metastatic Gastric Cancer: A Case Report

Case Report: Oxaliplatin-Induced Third-Degree Atrioventricular Block: First Discovery of an Important Side-Effect

Lynch Syndrome and Long QT Syndrome – As If One Syndrome is Not Already Enough

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