Cardiotoxicity induced by capecitabine and oxaliplatin in gastric cancer treatment: a rare case of cardiac arrest and cardiogenic shock
  • Muhammad Umer Riaz Gondal
    Department of Internal Medicine, Reading Hospital, West Reading, USA
  • John Lemoine
    Department of Internal Medicine, Drexel University, West Reading, USA
  • Jared Segal
    Department of Cardiology, Reading Hospital, West Reading, USA
  • Zainab Kiyani
    Department of Internal Medicine, Islamabad Medical and Dental College, Islamabad, Pakistan
  • Muhammad Ibraiz Bilal
    Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, USA
  • Fawwad Ansari
    Department of Internal Medicine, Piedmont Athens Regional, Athens, USA
  • Brian McCauley
    Department of Cardiology, Reading Hospital, West Reading, USA

Keywords

Oxaliplatin, capecitabine, QT prolongation, cardiogenic shock

Abstract

Introduction: Combination-based adjuvant chemotherapy utilising capecitabine and oxaliplatin is widely used in gastric cancer treatment. Rare but severe cardiac events such as prolonged QT, cardiac arrest and cardiogenic shock can result from their use.
Case description: A 45-year-old female with gastric adenocarcinoma was started on capecitabine-oxaliplatin chemotherapy one week before presenting to the emergency department with weakness. Blood pressure was 78/56 mmHg, heart rate 140 bpm and oxygen saturation 85%. She became unresponsive with pulseless ventricular fibrillation; CPR was initiated with immediate intubation. She received two shocks with a return of spontaneous circulation. Laboratory tests revealed serum potassium (3.1 mmol/l), magnesium (1.1 mg/dl) and troponin (0.46 ng/ml). An EKG revealed sinus tachycardia with a prolonged QT interval (556 ms). The combined effects of capecitabine, oxaliplatin and electrolyte abnormalities likely contributed to the QT prolongation. An echocardiogram demonstrated an ejection fraction of 10%–15%. An emergent right-heart catheterisation showed right atrial pressure of 10 mmHg and pulmonary artery pressure of 30/18 mmHg; cardiac output and index were not recorded. An intra-aortic balloon pump was placed, and she was admitted to the ICU for cardiogenic shock requiring norepinephrine, vasopressin and dobutamine. A repeat echocardiogram showed a significantly improved ejection fraction of 65%, and she was discharged.
Discussion: Capecitabine and oxaliplatin cardiotoxicity is an exceedingly rare occurrence, with both drugs reported to cause QT prolongation.
Conclusion: Healthcare providers must recognise the QT prolongation effects of capecitabine and oxaliplatin, leading to life-threatening cardiac arrhythmias.

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    Published: 2024-03-21
    Issue: 2024: Vol 11 No 4 (view)

    How to cite:
    1.
    Gondal MUR, Lemoine J, Segal J, Kiyani Z, Bilal MI, Ansari F, McCauley B. Cardiotoxicity induced by capecitabine and oxaliplatin in gastric cancer treatment: a rare case of cardiac arrest and cardiogenic shock. EJCRIM 2024;11 doi:10.12890/2024_004417.

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