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Table 6 Clinical synopsis of all cardiovascular adverse events requiring hospitalization during pazopanib treatment

From: Assessment of pazopanib-related hypertension, cardiac dysfunction and identification of clinical risk factors for their development

Age (years) Gender Pazopanib dose at time of event (mg) Cardiac drugs at event Time until event (days) Type of Cardiovascular event Past cardiac history and clinical synopsis Notable cardiac diagnostic findings Outcome
67 Male 800 None 30 Cardiogenic Shock H/O grade II diastolic dysfunction and 2nd degree AV block SP PPM. SB at rest and LE edema. BNP = 2567. Troponin normal. LVEF decline noted from 56% pre-pazopanib to 27% after pazopanib. No wall motion abnormalities detected on TTE. Pazopanib discontinued on admission. Treated with furosemide with initial improvement but developed cardiogenic shock and subsequent PEA arrest and death.
60 Female 800 None 16 Acute HFrEF No previous cardiac history. SB, orthopnea. JVP elevated. BNP = 3712. Troponin normal. LVEF = 10% on CMR. No previous LVEF available for comparison. Mid-myocardial fibrosis and elevated extracellular volume fraction of 35% (normal <29%) suggestive of non-ischemic cardiomyopathy Pazopanib discontinued. Treated with IV furosemide and started GDMT. Re-admitted two weeks later for hypotension and uncontrolled cancer-related pain. Due to hypotension was unable to tolerate GDMT for HFrEF.
59 Male 800 Atorvastatin, furosemide, ramipril, pioglitazone, metformin, warfarin 37 Atrial flutter H/O HTN, DM, HLD developed new-onset atrial flutter 12 days after spinal and hip surgery for metastatic bone cancer. LVEF 55-60% on TEE. EPS confirmed the mechanism of tachycardia to be right atrial flutter within the cavo-tricuspid isthmus. Successful TEE-guided DCCV restored normal sinus rhythm, followed by ablation. Patient deceased nine months after event due to progression of malignancy.
85 Female 800 Aspirin, diltiazem, simvastatin 662 Ischemic Left Lower Extremity H/O CAD, CVA, HLD, HTN, PAD with two prior percutaneous interventions to lower extremities preceding pazopanib initiation. Developed left leg pain. Non-emergent presentation. Totally occluded left popliteal artery. Multiple 70-80% stenotic lesions of the left superficial femoral artery. Occlusion of the left peroneal artery. Successful percutaneous intervention. Pazopanib was continued without any recurrent ischemic events for the remainder of the study period.
  1. H/O history of, SP status post, AV atrioventricular, PPM permanent pacemaker, SB shortness of breath, LE lower extremity, BNP brain natriuretic peptide, LVEF left ventricular ejection fraction, TTE transthoracic echocardiogram, PEA pulseless electrical activity, HFrEF heart failure with reduced ejection fraction, JVP jugular venous pressure, CMR cardiac magnetic resonance, IV intravenous, GDMT guideline directed medical therapy, HTN hypertension, DM diabetes mellitus, HLD hyperlipidemia, TEE transesophageal echocardiogram, EPS electrophysiology study, DCCV direct-current cardioversion, CAD coronary artery disease, CVA cerebrovascular disease, PAD peripheral arterial disease