Successful treatment of doxorubicin-induced cardiomyopathy with low-dose sacubitril/valsartan: a case report

Abstract

Background Cancer therapy-related cardiac dysfunction (CTRCD) is a challenging and life-threatening complication of many chemotherapeutic regimens. CTRCD prevention, diagnosis, and therapy require both careful interdisciplinary assessment and management. For patients with CTRCD, current guidelines of the European Society of Cardiology (ESC) recommend an angiotensin-converting-enzyme inhibitor (ACE-I) in combination with a beta-blocker (BB). Recent studies indicate a beneficial effect of sacubitril/valsartan in this patient population. Case summary A 68-year-old female patient with a pleural epithelioid angiosarcoma developed heart failure with reduced ejection fraction (HFrEF) and elevated serum biomarkers following doxorubicin treatment. After implementation of a recommended cardioprotective medical therapy including torasemide, rampril, carvedilol and spironolactone, the patient suffered two cardiac decompensations within four weeks after initiation of a paclitaxel regimen and pleural radiation therapy due to pain exacerbation. Despite a continuous application of the cardioprotective medical treatment regimen, no improvement of left-ventricular ejection fraction (LVEF) was detected in a four-months follow-up. Interestingly, after omitting ramipril and implementing low-dose sacubitril/valsartan (26/24 mg), we observed a decrease in serum biomarkers within three months as well as a significant improvement of LVEF within six months. After nearly ten months of disease stabilization under paclitaxel, the patient suffered progressive cancer disease and deceased one week later after the initiation of a therapeutic attempt with pazopanib. Discussion This case report highlights the importance of interdisciplinary care in cancer patients as well as the promising role of (low-dose) Sacubitril/Valsartan in patients with CTRCD even in the setting of delayed initiation.

Sacubitril/valsartan ameliorates cardiac function and ventricular remodeling in CHF rats via the inhibition of the tryptophan/kynurenine metabolism and inflammation

“…Specifically, sacubitril/valsartan reduces the levels of TNF-α, IL-1β, IL-6, and NT-proBNP in doxorubicin-induced cardiotoxic mice 24 . In another clinical case report, sacubitril/valsartan was shown to effectively treat doxorubicin-induced cardiomyopathy 25 . Similarly, empagliflozin, an inhibitor of sodium-glucose cotransporter 2 (SGLT-2), showed cardioprotective effects in mice exposed to doxorubicin-induced cardiotoxicity.…”