Gemcitabine Cardiotoxicity: Two Case Report and Review of the Literature

Gemcitabine is a chemotherapy treatment that is generally well tolerated, also in elderly patients. In Phases 1 and 2 clinical studies, there was no increased risk of cardiac toxicity. However, in our clinical practice, we have managed two patients in their nineties with cardiovascular events on gemcitabine : one patient with a heart attack and arrhythmia, the other patient in heart decompensation on a paroxysmal arrhythmia. In the literature, there are 15 cases of cardiovascular events on gemcitabine monotherapy and 6 cases on gemcitabine in combination with a platinum salt. The cardiotoxicity of gemcitabine in the elderly is underestimated due to comorbidities and multidrug therapy. Gemcitabine may be a potential cause although the exact mechanism remains unknown. At-risk patients could be targeted for adaptation of infusion modalities by reducing volumes, increasing surveillance and more systematic data reporting.