Belzutifan‐Associated Reversible Heart Failure With Preserved Ejection Fraction in Metastatic Renal Cell Carcinoma

Figures

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  FIGURE 1. Serial contrast‐enhanced computed tomography findings during systemic therapy. (A, B) At initial diagnosis, contrast‐enhanced computed tomography demonstrated bilateral renal tumors (A) and pulmonary metastases (B). Pancreatic metastasis was also identified but is not shown. The disease was staged as cT3aN0M1. (C, D) After prior systemic therapy, the pulmonary and pancreatic metastases had achieved complete response, whereas the bilateral renal tumors remained. (E, F) Immediately before initiation of belzutifan, the bilateral renal tumors showed disease progression (E), and new mediastinal and right hilar lymph node metastases were identified (F), leading to initiation of belzutifan as third‐line therapy.

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  FIGURE 2. Serial chest radiographs during the clinical course. (A) At initiation of belzutifan therapy, showing normal cardiac size (CTR, 41.4%) without pleural effusion. (B) On the day of admission (27 days after belzutifan initiation), demonstrating marked cardiomegaly (CTR, 63.4%) and bilateral pleural effusions. (C) Hospital day 5, showing transient worsening of pulmonary congestion and pleural effusion despite initiation of heart failure therapy. (D) Hospital day 16, on the day of belzutifan rechallenge, demonstrating improvement in cardiomegaly (CTR, 47.3%). (E) Eighteen days after belzutifan rechallenge, showing no recurrence of cardiomegaly (CTR, 44.8%). (F) One day after discontinuation of belzutifan, showing normal cardiac size (CTR, 42.1%).

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  FIGURE 3. Clinical course after hospitalization. Changes in body weight (solid circles), cardiothoracic ratio (CTR; squares), and oxygen requirement (triangles) during hospitalization are shown. Belzutifan was discontinued on admission, followed by initiation of heart failure therapy, resulting in progressive reductions in body weight, CTR, and oxygen requirement. Belzutifan rechallenge at a reduced dose (80 mg) was performed on hospital day 16.