Key result
Mavacamten relieves refractory obstructive HCM symptoms in a patient with metastatic cancer.
Why the study?
Management of obstructive hypertrophic cardiomyopathy in patients with malignancy and life-threatening symptoms presents complex clinical challenges requiring novel therapeutic approaches.
Case Report (n=1)
Mavacamten can be successfully utilized for dynamic left ventricular outflow tract obstruction in complex cardio-oncology patients when guided by multidisciplinary decision-making.
May support mavacamten in select critical cardio-oncology LVOTO cases with multidisciplinary input; leaves open need for prospective trials.
BACKGROUND: A 79-year-old woman admitted to critical care with obstructive hypertrophic cardiomyopathy and metastatic pancreatic neuroendocrine tumor presented with recurrent pulmonary edema and hemodynamic compromise from dynamic left ventricular outflow tract obstruction. CASE SUMMARY: Mavacamten was initiated, leading to rapid symptomatic improvement. However, during the course of treatment, the patient developed marked liver enzyme elevation, raising concern for drug-induced liver injury or an alternate oncological diagnosis. DISCUSSION: Multidisciplinary discussion was essential for reaching the final diagnosis of biliary obstruction and restarting mavacamten, breaking the vicious circle of recurrent presyncope and pulmonary edema secondary to dynamic left ventricular outflow tract obstruction. TAKE-HOME MESSAGE: Multidisciplinary decision-making is paramount when considering novel therapies in complex cardio-oncology patients.
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Llamedo et al. (2026) conducted a case report in Obstructive hypertrophic cardiomyopathy and metastatic pancreatic neuroendocrine tumor (n=1). Mavacamten was evaluated on Symptomatic improvement. Mavacamten led to rapid symptomatic improvement and broke the cycle of recurrent presyncope and pulmonary edema in a patient with obstructive HCM and metastatic malignancy.
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