Unveiling a Rare Complication: Gemcitabine-Induced Cardiomyopathy in Ovarian Serous Adenocarcinoma

Case Report

Austin J Clin Case Rep. 2023; 10(6): 1298.

Unveiling a Rare Complication: Gemcitabine-Induced Cardiomyopathy in Ovarian Serous Adenocarcinoma

Muhammad Nabeel¹*; Khubaib Ali²

¹Department of Clinical Oncology Pharmacy, Cancer Care Hospital & Research Centre, Lahore, Punjab, Pakistan

²Akhtar Saeed College of Pharmaceutical Sciences, Bahria Town, Lahore, Punjab, Pakistan

*Corresponding author: Muhammad Nabeel Department of Clinical Oncology Pharmacy, Cancer Care Hospital & Research Centre, Lahore, Punjab, Pakistan Tel: +92-321-4873-648 Email: nabeelsheikh26@gmail.com

Received: July 17, 2023 Accepted: August 28, 2023 Published: September 04, 2023

Abstract

Gemcitabine is a nucleoside analogue and pyrimidine antimetabolite authorized for the treatment of ovarian cancer. It is generally considered safe and well-tolerated, with only a few reported cases of cardiac adverse effects. However, we present a case of gemcitabine-induced dilated cardiomyopathy in a 33-year-old female receiving gemcitabine as second-line therapy for ovarian serous adenocarcinoma. The patient had no history of hypertension or significant cardiac issues. She presented with clinical symptoms, laboratory abnormalities, and imaging findings consistent with congestive cardiac failure, along with a Left Ventricular Ejection Fraction (LVEF) of 25-30%. Gemcitabine administration was immediately discontinued, and treatment with Furosemide, ACE inhibitors, and Beta-blocker agents was initiated. Subsequently, the patient’s condition improved, with the resolution of symptoms and normalization of cardiac findings upon discontinuation of gemcitabine. This is the first reported case demonstrating objective evidence of gemcitabine-induced dilated cardiomyopathy in a patient with ovarian serous adenocarcinoma without a significant cardiac history. Although rare, it is crucial to promptly diagnose gemcitabine-induced cardiomyopathy to initiate appropriate management protocols.

Keywords: Gemcitabine; Cardio-oncology; Cardiomyopathy; Cardiotoxicity; Ovarian cancer

Introduction

Cancer is rapidly emerging as the second leading cause of mortality worldwide, primarily due to the alarming increase in cancer incidence and treatment complications. The overall annual cancer cases are on a significant rise, leading to increased morbidity and mortality. Despite advancements in cancer treatment, the lack of effective curative therapies, along with adverse treatment effects, drug resistance, and tumor recurrence, contribute to these challenges [1]. Gemcitabine, a pyrimidine antimetabolite, and cytidine analogue, is widely used in the treatment of various solid organ malignancies [2,3]. It acts by inhibiting ribonucleotide reductase and DNA repair, thereby suppressing DNA synthesis. It is commonly employed in the management of lung, pancreatic, bladder, breast, ovarian, and bile duct carcinomas, as well as lymphomas and uterine sarcomas, either alone or in combination with other therapies [4]. Gemcitabine is often utilized as an adjuvant chemotherapy agent [5], due to its relatively lower toxicity profile compared to other anticancer drugs, making it well-tolerated and considered safe [6]. While myelosuppression is the most common side effect, gemcitabine has been associated with gastrointestinal disturbances (nausea, vomiting, and diarrhea) and abnormalities in liver and renal function tests [7]. Moreover, rare Adverse Drug Reactions (ADRs) have been reported, including thrombotic microangiopathy [8], interstitial pneumonitis [9], arterial fibrillation [10], and Capillary Leak Syndrome (CLS) [11]. Although gemcitabine has not shown a substantial risk of cardiotoxicity in phase 1 and 2 clinical studies, there have been a few reported cases of acute Myocardial Infarction (AMI) and arrhythmias associated with its widespread clinical use [2].

Here, we present a case of a 33-year-old female with stage 3 ovarian serous adenocarcinoma who developed dilated cardiomyopathy following gemcitabine chemotherapy for ovarian cancer treatment.

Case Presentation

In February 2022, a 33-year-old woman with no comorbidities presented with a two-year history of lower abdominal pain. A Computerized Tomography (CT) scan of the abdomen and pelvis revealed a significant malignant-looking pelvic mass originating from the right adnexa and extending into the lower abdomen. An ultrasound-guided biopsy of an anterior abdominal wall nodule was performed to obtain tissue for diagnosis. Cancer biomarkers mentioned in Table 1 were found to be positive, indicating the presence of cancer.

Further confirmation of the primary tumor was obtained through a Magnetic Resonance Imaging (MRI) scan, which diagnosed the patient with ovarian serous adenocarcinoma. She was initiated on neo-adjuvant chemotherapy using the carboplatin/paclitaxel (CARB+PAC) protocol to reduce the size of the cancer and prepare for subsequent debulking surgery.

Therapeutic Intervention

After completing 7 cycles of chemotherapy, an echocardiogram (Echo) was performed (Figure 1), revealing an increased thickness of the Left Ventricle (LV) wall without any abnormalities in systolic function. The Ejection Fraction (EF) was determined to be more than 55%. Exploratory laparotomy and bilateral ureteric stenting were performed, but the tumor was found to be inoperable due to its size, location, and involvement of nearby organs. Based on these findings, the oncology department recommended a change in the chemotherapy protocol from carboplatin/paclitaxel (CARB+PAC) to gemcitabine (1000 mg/m2 IV on days 1, 8, 15 on a 28-day cycle for six cycles) as the tumor appeared to be resistant to platinum-based chemotherapy.

Citation: Nabeel M, Ali K. Unveiling a Rare Complication: Gemcitabine-Induced Cardiomyopathy in Ovarian Serous Adenocarcinoma. Austin J Clin Case Rep. 2023; 10(6): 1298.