Cardio Oncology - Dr. Rakesh Gopal

11/07/2025

Lorlatinib induced Dyslipidemia

A 47-year-old lady with Non-Small Cell lung cancer, metastatic disease, was initially treated with ceritinib followed by Docetaxel. She was subsequently initiated on Lorlatinib. Hypertensive, on Bisoprolol. In 6 weeks, her total cholesterol shot up to 468 mg/dl, LDL 305.8, and triglyceride 451. Lorlatinib, an ALK inhibitor used to treat ALK-positive non-small cell lung cancer, can induce dyslipidemia in up to 80% of people treated. Increased intestinal lipid absorption and hepatic oversecretion of very-low-density lipoprotein particles may be the culprit.

Patient was started on 40 mg Rosuvastatin, 160 mg Bempedoic acid and Gemfibrozil 300 mg with advice to check lipid levels CPK SGOT SGPT after three months

10/07/2025

Amivantanab and thrombosis

36 year old lady with metastatic Non small cell lung cancer had progressive disease, status post two lines of conventional therapy . She was started on Amivantamab , Gemcite and Cisplatin. By the end of four weeks patient presented with pain and swelling of left side of neck . USG and dopler showed thrombosis of left Internal Jugular vein . Normal LV function/ RV function, no PAH . She was put on therapeutic anti coagulation .

Improved efficacy has been shown with amivantamab and amivantamab-based combination therapies in patients with epidermal growth factor receptor mutated non-small cell lung cancer compared to established treatment options . Higher risk of venous thromboembolism is observed in patients treated with amivantamab-based therapies, with considerable differences in VTE risk according to the line of systemic treatment, concomitant treatment with lazertinib, osimertinib and intravenous vs. subcutaneous amivantamab administration .
In clinical trials patients on combination therapy is being prophylactically anticoagulated .

Lazertinib is an oral, irreversible, third-generation EGFR tyrosine kinase inhibitor used to treat non-small cell lung cancer with specific EGFR mutations.

Osimertinib is a third generation EGFR tyrosine kinase inhibitor used to treat non-small cell lung cancer with specific epidermal growth factor gene mutations.

Both drugs are associated with thromboembolism.

05/07/2025

Post chemotherapy. New onset LV dysfunction. Strain rate imaging correlates.

03/07/2025

Ovarian cancer . What is brewing in right atrium? LA is normal . Thrombus ? Chiary network?

05/06/2025

Recurrent ischaemic stroke in cancer patient. No fever . May be endocarditis . Fungal .

05/06/2025

57 year old lady with no coronary risk factors events or symptoms received Cisplatin and Gemcitabine for cancer . She had acute ST elevation infero lateral myocardial infarction on day 3 though occasional rest angina was present from the day she finished chemotherapy . Thrombolysed with Tenectaplase . Complete ST resolution and pain relief . CAG showed Recanalised Proximal LAD . No LCx or RCA disease . These drugs can cause CRS and Acute myocardial infarction . Rechallenge may not be safe .

06/03/2025

03/03/2025

26 year old with testicular tumor . Has secondaries. This time admitted for chemotherapy with Paclitaxel Gemcitabine and carboplatin. Patient had acute ST elevation anterior wall MI . He was thrombolysed with tenectaplase and standard of care for ACS . Primary angioplasty was not considered as we find either normal coronaries or a thrombus filled artery in such cases especially those who have no coronary risk factors or prior events or symptoms . Day 3 , his clexane and aspirin was stopped and Eliquis and Plavix was continued. A CT angiogram done at three weeks showed normal coronaries. No evidence of atherosclerosis. Acute cardiac events during cancer therapy is a different ball game

22/02/2025

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