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.
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.