Acute heart failure following the initiation of cabozantinib, a multikinase inhibitor: A case report

Cabozantinib is a multikinase inhibitor that exerts anticancer activity against malignancies such as renal tumors and leukemia. Although other agents that belong to the same category can cause cardiotoxicity, there is a paucity of information on the safety profile of cabozantinib. Herein, we present the case of a 62-year-old woman who developed acute heart failure (HF) following the initiation of cabozantinib for a metastatic renal tumor. She had no history of cardiovascular disease. Echocardiography prior to chemotherapy revealed normal cardiac function. However, she developed sudden onset of dyspnea 23 days following cabozantinib initiation. The chest X-ray showed newly developed congestion and cardiomegaly, and echocardiography revealed severe impairment of systolic and diastolic function. She was referred to the intensive care unit for non-invasive positive pressure ventilation and infusion of inotropes. The cardiac function fairly recovered on day 46; thereafter, supportive therapy, followed by guideline-directed medical therapy for HF with reduced ejection fraction was provided. We describe the first case of severe acute HF following cabozantinib initiation without underlying heart disease. Clinicians should plan follow-up schedules and be cautious of the development of HF when they initiate the agent, even if patients appear to have a low cardiovascular disease risk. LEARNING OBJECTIVES: • We report the first case of acute heart failure following cabozantinib initiation without an underlying heart disease. • Prompt discontinuation of the agent and supportive therapy with guideline-directed medications can allow adequate recovery of cardiac function, even if the severity of heart failure is high. • Careful follow-up following the initiation is warranted when clinicians plan to initiate cabozantinib, even if patients appear to have low risk of cardiovascular disease.