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Gemcitabine Cardiac Toxicity — SCE Medical Oncology MCQ

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HardGI CancersGemcitabine Cardiac ToxicitySCE Medical Oncology

A 55-year-old man with pancreatic cancer develops new-onset atrial fibrillation during gemcitabine infusion. He has no prior cardiac history. What should be considered?

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Correct answer: C — Gemcitabine can rarely cause cardiac toxicity including supraventricular arrhythmias, myocardial ischaemia and heart failure — cardiology review and ECG monitoring are warranted; gemcitabine continuation requires risk-benefit assessment

Gemcitabine-induced cardiac toxicity is rare (~1%) but includes: supraventricular arrhythmias (AF, atrial flutter), myocardial ischaemia, heart failure and pericardial effusion. Risk factors: pre-existing cardiac disease, concurrent radiation, prior anthracycline exposure. Management: cardiology assessment, rate/rhythm control for AF, troponin monitoring. Decision to continue gemcitabine requires risk-benefit discussion. Alternative regimens (FOLFIRINOX) may be preferred if cardiac toxicity is significant.

Reference: BNF Gemcitabine; ESMO Cardio-Oncology; Rao et al Cancer 2014