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Updated: Sep 8, 2025

A Doxorubicin-Induced Murine Model of Dilated Cardiomyopathy In Vivo
Published on: May 16, 2020
Left Ventricular Dysfunction Caused by Combined Pembrolizumab and Lenvatinib Following Doxorubicin: Which Agent Is
Yoshihide Ishikawa1, Masataka Suzuki1, Eri Konda2
1Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.
Background:
Combination chemotherapy has improved cancer outcomes; however, identifying suspected cardiotoxic chemotherapies can be challenging when multiple chemotherapies are initiated simultaneously.
Case Summary:
A 58-year-old woman with endometrial cancer developed heart failure, with a reduced left ventricular ejection fraction of 26%, 10 months after combined pembrolizumab and lenvatinib after doxorubicin. Cardiac magnetic resonance revealed acute myocarditis. Endomyocardial biopsy revealed interstitial fibrosis and scattered CD3-positive T-lymphocyte infiltration without myocytic necrosis. After discontinuation of pembrolizumab and lenvatinib, left ventricular function recovered without steroids. Pembrolizumab monotherapy was resumed for lung metastasis.
Discussion:
This case highlights the importance of identifying different cardiotoxic mechanisms. Potential causes of left ventricular dysfunction could overlap with immune checkpoint inhibitor-induced myocarditis from pembrolizumab and reversible cardiotoxicity from lenvatinib, based on myocardial fibrosis caused by doxorubicin cardiotoxicity.
Take-Home Message:
Multidisciplinary discussions are crucial for identifying suspected cardiotoxic chemotherapy and exploring additional chemotherapy options, including rechallenging immune checkpoint inhibitors.
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