Key result
In a 68-year-old female with doxorubicin-induced cardiomyopathy, switching from ramipril to low-dose sacubitril/valsartan decreased serum biomarkers and significantly improved LVEF within 6 months.
Why the study?
Cancer therapy-related cardiac dysfunction is a challenging complication where guidelines recommend an ACE inhibitor plus beta-blocker, while studies indicate a potential beneficial effect of sacubitril/valsartan.
Does low-dose sacubitril/valsartan improve LVEF and biomarkers in a patient with doxorubicin-induced cardiomyopathy?
Case Report (n=1)
Does low-dose sacubitril/valsartan improve LVEF and biomarkers in a patient with doxorubicin-induced cardiomyopathy?
Low-dose sacubitril/valsartan may be an effective treatment for doxorubicin-induced cardiomyopathy, even when initiated after a delay and failure of standard ACE inhibitor therapy.
May support ARNI in doxorubicin cardiomyopathy; hypothesis-generating and requires RCT confirmation before practice change.
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 in combination with a beta-blocker. 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 and elevated serum biomarkers following doxorubicin treatment. After implementation of a recommended cardioprotective medical therapy including torasemide, ramipril, carvedilol, and spironolactone, the patient suffered two cardiac decompensations within 4 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 4-month follow up. Interestingly, after omitting ramipril and implementing low-dose sacubitril/valsartan (26/24 mg), we observed a decrease in serum biomarkers within 3 months as well as a significant improvement of LVEF within 6 months. After nearly 10 months of disease stabilization under paclitaxel, the patient suffered progressive cancer disease and deceased 1 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.
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Bell et al. (2022) conducted a case report in Doxorubicin-induced cardiomyopathy (Cancer therapy-related cardiac dysfunction) (n=1). Sacubitril/valsartan vs. Ramipril (prior therapy) was evaluated on Decrease in serum biomarkers and improvement of left-ventricular ejection fraction (LVEF). In a 68-year-old female with doxorubicin-induced cardiomyopathy, switching from ramipril to low-dose sacubitril/valsartan decreased serum biomarkers and significantly improved LVEF within 6 months.
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