title: Congestive heart failure secondary to gemcitabine nab-paclitaxel in patients with pancreatic cancer.
abstract: BACKGROUND
  Gemcitabine plus nab-paclitaxel is a novel combination chemotherapy that is currently being used in patients with metastatic pancreatic cancer. Phase III trials have shown improved survival, response rates, and disease-free progression. The most significant side-effects include peripheral neuropathy and myelotoxicity. Review of literature has shown rare cases of congestive heart failure associated with gemcitabine plus nab-paclitaxel. We describe two cases of women who were treated with gemcitabine plus nab-paclitaxel for pancreatic adenocarcinoma who developed acute exacerbation of congestive heart failure.
  
  
  METHODS
  Two women with pancreatic adenocarcinoma were both treated with gemcitabine plus nab-paclitaxel and developed acute decompensated heart failure requiring hospitalization and standard treatment for heart failure including i.v. diuretics. Once chemotherapy was discontinued, symptoms resolved.
  
  
  CONCLUSIONS
  Based on review of literature, as far as we are aware of, this is the first report of congestive heart failure as an adverse effect of combination therapy. Both patients had evidence of diastolic dysfunction which may have predisposed them to cardiac toxicity secondary to gemcitabine plus nab-paclitaxel. The exact mechanism of action is currently unknown and requires further studies. However, it is imperative for physicians to be aware of this adverse effect and closely monitor patients with underlying heart disease who are undergoing treatment with gemcitabine plus nab-paclitaxel.
authors.affiliation: Tufts University School of Medicine, Tufts Cancer Center, Boston, MA, U.S.A.
authors.forename: Preethi
authors.initials: P
authors.lastname: John
authors.affiliation: Tufts University School of Medicine, Tufts Cancer Center, Boston, MA, U.S.A.
authors.forename: Harriet
authors.initials: H
authors.lastname: Butler
authors.affiliation: Tufts University School of Medicine, Tufts Cancer Center, Boston, MA, U.S.A. wsaif@tuftsmedicalcenter.org.
authors.forename: Muhammad Wasif
authors.initials: MW
authors.lastname: Saif
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000368:Aged; D000418:Albumins / Q000009:adverse effects* / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology; D006801:Humans; D017239:Paclitaxel / Q000009:adverse effects* / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000093542:Gemcitabine
chemical_list: C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D000964:Antimetabolites, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D004232:Diuretics; D003841:Deoxycytidine; D017239:Paclitaxel; D000093542:Gemcitabine
keywords: Pancreatic cancer; congestive heart failure; gemcitabine; nab-paclitaxel