Cetuximab induced acute cardiotoxicity, a rare but severe side effect

Cetuximab is a monoclonal antibody that treats malignant disease by inhibiting epidermal growth factor receptors. Cetuximab has many common adverse events have been reported including infusion reactions, skin rashes, headache and gastrointestinal disturbances. Cardiactoxicity and cardiac complications such as heart failure (HF), myocardial ischaemia, arrhythmias, hypertension, and thromboembolism are some types of side effects of anticancer agents, cardiovascular complications are one of the most feared side-effects as they can increase mortality which interferes with the gain in life expectancy due to anticancer therapy. Up till now, cetuximab associated cardiotoxicity has been rarely reported in the literature. In this paper we are reporting a case of 89-year-old male diagnosed to have laryngeal squamous cell carcinoma with a history of hypertension but no history of coronary artery disease; he developed non-ST elevation myocardial infarction (NSTEMI) after receiving the loading dose of cetuximab; his case was deteriorated to develop heart failure and atrial fibrillation and required admission to cardiac intensive care unit (CCU) on mechanical ventilation. Assessment of cardiac toxicity remains a critical issue in cancer management; physicians should be aware of the potential for cardiotoxicity associated with the administration of cetuximab. Before treatment with monoclonal antibodies; caution and baseline assessment are suggested for patients aged > 60 years, or with cardiovascular risk factors such as hypertension, hypercholesterolaemia, diabetes, obesity, or with a history of coronary artery disease, congestive heart failure, or arrhythmias,critical monitoring of serum electrolytes (including magnesium, potassium and calcium) should be monitored during and after treatment.