Cabozantinib-related cardiotoxicity: a prospective analysis in a real-world cohort of metastatic renal cell carcinoma patients

Roberto Iacovelli, Chiara Ciccarese, Giuseppe Fornarini, Francesco Massari, Davide Bimbatti, Claudia Mosillo, Sara Elena Rebuzzi, Vincenzo Di Nunno, Massimiliano Grassi, Emanuela Fantinel, Andrea Ardizzoni, Giampaolo Tortora

Research output: Contribution to journalArticlepeer-review


Aims: Data regarding the cardiac toxicity of cabozantinib lacks. The aim of our study was to assess the risk of cabozantinib-related cardiotoxicity in mRCC patients. Methods: We performed a multicentre prospective study on mRCC patients treated with cabozantinib between October 2016 and November 2017. Transthoracic echocardiogram and plasma biomarkers assay were assessed at baseline, 3 and 6 months after cabozantinib initiation. Results: The study population included 22 mRCC patients. At baseline, 9.1% had a reduced left ventricular ejection fraction (LVEF), but none had a left ventricular systolic dysfunction. Patients with baseline reduced LVEF did not show further significant LVEF modification after 3 months. After 6 months, only 1 had an LVEF decline >10% compared to baseline, resulting in LV systolic dysfunction. At baseline, 64.7% and 27.3% of patients had elevated precursor brain natriuretic peptide (proBNP) and high-sensitivity troponin I (hsTnI), respectively. Among patients with basal normal proBNP and hsTnI, none had elevated values at 3 and 6 months. No correlation was found between basal elevated proBNP and basal reduced LVEF (P =.29), and between elevated proBNP and reduced LVEF after 6 months (P =.37). Similarly, we found no correlations between elevated hsTnI and reduced LVEF or elevated proBNP at baseline (P =.47; P =.38), at 3 (P =.059; P =.45) and after 6 months (P =.72; P = 1.0). Conclusions: This prospective study revealed a modest risk of developing left ventricular systolic dysfunction related to cabozantinib. A lack of correlation between elevated cardiac biomarkers and reduced LVEF at different time-points was detected. Assessments of the cardiac function should be reserved at the occurrence of clinical symptoms.

Original languageEnglish
Pages (from-to)1283-1289
Number of pages7
JournalBritish Journal of Clinical Pharmacology
Issue number6
Publication statusPublished - Jun 1 2019


  • cabozantinib
  • cardiotoxicity
  • high-sensitivity troponin I
  • metastatic renal cell carcinoma
  • precursor brain natriuretic peptide

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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