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

Abstract

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.

Keywords: Oxaliplatin; Stomach neoplasms; Takotsubo cardiomyopathy.

Fig. 1.

Coronary angiography image. Coronary arteries with no angiographically significant lesions. a Right coronary artery. b Left coronary artery.

Fig. 2.

Left ventriculography image. Anteroapical ballooning. a Telediastolic frame. b Telesystolic frame.

Fig. 3.

Cardiac magnetic resonance imaging. No signs of edema, fibrosis, or chronic inflammatory process at the myocardial level.

Fig. 4.

Timeline of the main events of the case.