Pulmonary Embolism And Bradycardia in a NSCLC Patient Treated With Crizotinib For a Rare Mutation: A Case Report

Lung cancer is a major global health problem because of its high incidence and mortality. Targeted therapies have transformed treatment of driver-mutated metastatic non-small cell lung cancer (NSCLC). Nevertheless, recent studies demonstrated that cardiovascular disease (CVD) was the second leading cause of mortality in cancer survivors now, management of patients’ cardiovascular health during the course of anticancer therapy has become a great challenge faced by the oncologists. Anticancer related CV complications are not limited to traditional chemotherapy, but are also increasingly recognized in targeted therapy. We present a case of pulmonary embolism and bradycardia in a 91-year-old NSCLC patient treated with crizotinib for a rare MET Y1003S mutation. To our knowledge, this is the second report to show antitumor response of crizotinib in lung cancer patients with such a rare mutation. However, the patient complained chest tightness and shortness of breath after a month of standard dose crizotinib therapy. Non-invasive examination revealed new onset bradycardia and pulmonary embolism (PE). Such clinical manifestations were associated with targeted therapy-related cardiovascular（CV）toxicity, on which the emerging discipline cardio-oncology focused, and a multidisciplinary investigation and treatment was conducted. The case highlights the CV adverse events of novel therapies and the current challenges to be tackled in cardio-oncology.