Left ventricular dysfunction associated with axitinib and nivolumab experience in an advanced renal cell carcinoma

Abstract

Tyrosine kinase inhibitors and immune checkpoint inhibitors are widely used in advanced renal cell carcinoma. Here we reported a left ventricular dysfunction associated with axitinib and nivolumab experience in this patient with heart failure. A 70-year-old male patient with advanced renal cell carcinoma was treated with interferon alpha-2b 10 million U thrice weekly. After progression, sunitinib provided 18 months of stable disease. In third line, the patient was treated with axitinib 10 mg daily. Under axitinib, the patient presented with dyspnea and palpitations. The diagnostic work-up showed a left ventricular dysfunction with an ejection fraction (EF) of 35% in echocardiography. He was treated with diuretics, acetylsalicylic acid 100 mg and low molecular weight heparin. Management and outcome: After excluding cardiac ischemic and pulmonary pathologies, we concluded a possible adverse event diagnosis of axitinib-related cardiotoxicity. After close follow up for cardiac dysfunction, the patient was treated with nivolumab 3 mg/kg every two weeks. The initial EF was 32%. After three months therapy, the patient was asymptomatic for cardiac dysfunction and EF was 50%. CT scan showed partial response in pulmonary lesions. We have limited no data about cardiotoxicity associated axitinib and limited data about ICIPs. Our case is unique by providing data about how to manage a metastatic RCC patient with left ventricular dysfunction under axitinib and how to follow-up the cardiac functions while under nivolumab therapy.