Bevacizumab Induced Cardiomyopathy in a Patient with Adult Congenital Heart Disease: A Case Report and Brief Review

Background: Cardiac dysfunction is an unusual but documented side effect of many forms of antineoplastic therapy. Bevacizumab is a novel antineoplastic agent that inhibits VEGF-A with a low reported incidence of cardiotoxicity (1.7 - 3%) derived primarily from clinical trials of women with breast cancer which captured adverse events of symptomatic heart failure. Subsequent studies suggest the incidence of asymptomatic decline in cardiac function may be closer to 20%. Untreated declines in cardiac function are associated with increased morbidity and mortality, early recognition and treatment can improve outcomes. Case Report: Here we describe a case of a 51 year old male being treated with Bevacizumab for metastatic neuroendocrine cancer of the colon who developed a severe asymptomatic decline in cardiac function. With interruption of Bevacizumab and implementation of heart failure therapy his cardiac function returned to baseline. Conclusion: Early recognition and application of heart failure disease modifying therapy can decrease the risk and improve the likelihood of recovery in cases of chemotherapy induced cardiac dysfunction. Baseline cardiac testing and standardized surveillance can increase the opportunities for early intervention and may improve long term outcomes.