Table 6 Cancer therapy-related MACCE events in the cohort, adjudicated as cardiotoxicity events
From: Outcomes of malignancy in adults with congenital heart disease: a single center experience
Patient ID | ACHD diagnoses | MACCE prior to cancer therapy | Primary cancer | Cancer Therapy | Therapy-related MACCE | Time of therapy-related MACCE episode from initiation of therapy | Management of suspected cardiotoxicity | Outcome of cardiotoxic episode | Cancer-related outcome |
|---|---|---|---|---|---|---|---|---|---|
3 | • ASD • VSD • Subaortic membrane | None | Melanoma | Ipilimumab/ nivolumab | New non-ischemic cardiomyopathy with heart failure. LVEF decreased from 53 to 36% after first cycle of immunotherapy | 31 days | • Ipilimumab discontinued, switched to trametinib. • Furosemide, carvedilol, spironolactone and lisinopril started | • Improvement in LV EF and volume status. • Able to tolerate additional cycles of therapy | • New brain metastases discovered • Suffered large intracranial hemorrhage due to gamma-knife treatment • Died shortly after comfort care initiated |
11 | • Bicuspid aortic valve • Mitral valve prolapse | • SVT, paroxysmal AF • Known LV cardiomyopathy (LVEF 35%) due to ventricular pacing/ mid-LAD 70% plaque | Mantle cell lymphoma | Bendamustine/ rituximab (BR) | Decompensated heart failure, with 1.2 L administration of fluids with first cycle | Same day as initiation | Prophylactic furosemide before each subsequent cycle | • Fluid status well-managed, no further decompensation or change in LV function. • Completed 4 cycles of BR. | Remission followed by relapse |
11 | • Bicuspid aortic valve • Mitral valve prolapse | Same as above | Mantle cell lymphoma | Ibrutinib | Decompensated heart failure. No changes to LV EF or valve function | 30 days | • Discontinuation of ibrutinib, • Initiation of bendamustine/ rituximab (BR) with scheduled hospitalization for management of fluid status with each dose | • Fluid status improved. • Subsequent doses of BR given with intravenous furosemide during scheduled admissions • Tolerated BR therapy well | • Progression to blast crisis • Died shortly after comfort care initiated |
21 | Bicuspid aortic valve | None | Hodgkin’s lymphoma | Mediastinal radiation | • Radiation pericarditis • Radiation induced severe valvulitis of the aortic, tricuspid and mitral valves | Unknown | • Pericardial window • surgical tricuspid valve replacement. | • Worsening heart failure due to severe mitral and aortic regurgitation. • Deemed unintervenable due to poor functional status from metastatic lung cancer | • Hodgkin’s lymphoma with remission • Metastatic small-cell lung cancer diagnosed approximately 35 years later, progressed despite immunotherapy. • Died shortly after being placed on palliative care for advanced cancer and heart failure |
41 | • Double outlet right ventricle (unintervened) • Pulmonic stenosis • VSD | Paroxysmal AF | Urothelial carcinoma | Gemcitabine/ cisplatin | • Acute chest pain with elevated troponin-I level to 0.86 ng/mL in setting of gastrocnemius vein thrombosis. • No pulmonary embolism found | 28 days | Conservative management advised since symptoms resolved. | • None, no recurrence in symptoms and hence no additional ischemia evaluation pursued • Received another 2 cycles of gemcitabine/ cisplatin | • Completed 3 cycles of neoadjuvant gemcitabine/ cisplatin • Underwent robotic nephroureterectomy and cystectomy. Currently under surveillance |
44 | Bicuspid aortic valve | • None • Known severe aortic regurgitation with LV dilation and preserved LVEF | B-cell acute lymphoblastic leukemia | • Stem cell transplantation, thiotepa and fludarabine. • Previously received ABFM induction including 18.75 mg/m2 of anthracycline + 2 cycles of blinatumomab. | Acute pulmonary edema resulting in hypoxic respiratory failure | 10 days after stem cell transplantation, 6 months after induction | Aggressive high-dose intravenous diuretic therapy instituted | • Normalization of volume status • Maintenance oral diuretic therapy instituted • Continued on losartan and carvedilol | • Relapsed 6 months after stem cell transplantation • Currently back on blinatumomab therapy |
58 | Pulmonary valve stenosis | • None. • Known severe pulmonary regurgitation with normal right ventricular systolic function | Concomitant invasive ductal and lobular carcinoma in the same breast | TCH (taxotere/ carboplatin, herceptin) | • Progressive right-sided heart failure with each cycle, worst after completion of 6th and final cycle of TCH. • No changes to ventricular systolic function on echocardiogram | 21 days after 1st cycle | Oral diuretic therapy | • Normalization of volume status and resolution of heart failure • Maintenance diuretic therapy instituted | • Underwent prophylactic right breast mastectomy. • Currently in remission |