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Review
. 2022 Nov;14(16):1297-1305.
doi: 10.2217/imt-2022-0013. Epub 2022 Nov 21.

Takotsubo syndrome in a patient with metastatic renal cell carcinoma treated with pembrolizumab plus axitinib

Giulia Airò  1 , Michele Maffezzoli  1 , Alessandro Lazzarin  1 , Michele Bianconcini  2 , Alessandro Greco  2 , Sebastiano Buti  1   3 , Alessandro Leonetti  1   3
Affiliations
Review

Takotsubo syndrome in a patient with metastatic renal cell carcinoma treated with pembrolizumab plus axitinib

Giulia Airò et al. Immunotherapy. 2022 Nov.

Abstract

We report the case of a patient with metastatic renal cell carcinoma who developed Takotsubo syndrome (TTS) 6 days after starting pembrolizumab plus axitinib as first-line treatment. Coronary angiogram was negative for obstructive coronary artery disease and echocardiogram revealed a depressed left ventricular ejection fraction with apical akinesis. Axitinib was discontinued and myocardial contractile function fully recovered 23 days after the initial presentation. The treatment was safely resumed and granted a partial response of disease. A literature review regarding TTS in patients receiving VEGFR tyrosine kinase inhibitors and/or immune checkpoint inhibitors was performed. TTS is reported as a rare adverse event and the possible causal relationship between TTS and antineoplastic therapy is still unclear. Further research is warranted to better understand cardiotoxicity mechanisms and their management.

Keywords: Takotsubo syndrome; axitinib; mRCC; pembrolizumab; renal cell carcinoma.

Plain language summary

We report the case of a patient with metastatic renal cell carcinoma who developed a rare cardiac adverse event called Takotsubo syndrome 6 days after starting antineoplastic therapy with pembrolizumab plus axitinib. Axitinib was discontinued and cardiac function fully recovered 23 days after the initial presentation. The treatment was safely resumed and granted a partial response of disease. Takotsubo syndrome is reported as a rare adverse event and the possible causal relationship with antineoplastic therapy is still unclear. Further research is warranted to better understand cardiotoxicity mechanisms and their management.

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