A fatal case of cabozantinib-induced cardiomyopathy

Cabozantinib, a multi-kinase receptor inhibitor, is utilized in the treatment of advanced malignancies such as metastatic renal cancers. While rare, cabozantinib-induced cardiotoxicity has emerged as a recognized adverse effect with potentially reversible outcomes. We report the case of a 55-year-old male who developed fatal cardiomyopathy 4 months after initiating cabozantinib therapy. Despite its rarity, cardiomyopathy after initiation of cabozantinib can be lethal if not diagnosed early. This case underscores a significant gap in the surveillance of patients treated with newer agents like cabozantinib. Larger observational studies are needed to assess the prevalence and impact of cardiomyopathy after initiation of cabozantinib therapy, and to determine the cost–effectiveness of early surveillance protocols. Tyrosine kinase inhibitors (TKIs) have significantly improved cancer survival rates but carry risks of severe adverse effects, including cardiotoxicity. Cabozantinib is a potent TKI used for advanced renal cell carcinoma, hepatocellular carcinoma and medullary thyroid carcinoma. A 59-year-old male with a history of metastatic renal cell carcinoma and prior heart conditions developed fatal cardiomyopathy 4 months after starting cabozantinib. Initial symptoms included shortness of breath, pedal swelling and weight gain, progressing rapidly to cardiogenic shock. Cabozantinib-induced cardiomyopathy, though rare, can result from VEGFR inhibition affecting cardiac myocytes. Current guidelines recommend regular cardiac monitoring for early detection of cardiotoxicity in patients on TKIs. Our case reveals potential gaps in surveillance, suggesting the need for improved monitoring protocols. Early cardiac monitoring in patients on cabozantinib is crucial for preventing fatal outcomes. Larger studies are needed to understand the incidence and burden of cabozantinib-induced cardiomyopathy.