CONGRESS ABSTRACT

INTRODUCTION Cardiovascular toxicity associated with the use of anticancer drugs is one of the most feared complications and can limit or affect the continuation of therapy. This toxicity has been rarely described with the use of taxanes, to the point that no warning is included in the guidelines. CLINICAL CASE S. M. is a 62-years-old woman with no cardiovascular risk factors, diagnosed with pancreatic adenocarcinoma, who underwent surgery and then started adjuvant chemotherapy with paclitaxel and gemcitabine.                                                                                                                                                      After completing the paclitaxel infusion, the patient presented with constrictive chest pain lasting about 10-15 minutes, which resolved spontaneously. Upon cardiology evaluation, no electrocardiographic or echocardiographic abnormalities were observed, and two serial determinations of troponin were within normal limits. The following day, a coronary angiography showed normal epicardial coronary arteries however coronary vasoreactivity test with Acetylcholine on the left coronary artery revealed, even at the lowest dose (intracoronary infusion of 20 mcg of Ach), the onset of angina, ST-segment elevation, and angiographic evidence of diffuse vasospasm.                                                                                            During the hospitalization, therapy with diltiazem 120 mg/day was introduced and well tolerated. In agreemnet with the oncologists, a rechallenge of paclitaxel therapy was administered to the patient that this time remained asymptomatic. DISCUSSION In the literature, after the onset of vasospastic angina, which most often leads to acute coronary syndrome with ST-segment elevation, paclitaxel chemotherapy was discontinued, with non-negligible consequences on the prognosis of the underlying cancer. In our case, however, the "premedication" with a vasodilator (specifically a calcium antagonist) allowed for the continuation of oncological therapy. CONCLUSIONS   This clinical case highlights how, in a field like Cardio-oncology, close collaboration between different specialists can ensure excellent quality of medical care and the best management of the patient.