Rechallenge With Cisplatin After an Acute Coronary Event

Testicular cancer is the most common malignancy in young men, and cisplatin-based chemotherapy provides excellent long-term survival. However, cisplatin-associated cardiovascular toxicity spans a broad spectrum, and evidence guiding rechallenge after an acute coronary event is limited.

A 24-year-old man with testicular cancer and no cardiovascular risk factors developed chest pain and elevated troponins early in his cisplatin therapy. Coronary angiography revealed a nonocclusive left anterior descending artery thrombus. After treatment with antiplatelet and anticoagulant therapy, the thrombus resolved, and he subsequently underwent a carefully monitored cisplatin rechallenge.

Given cisplatin's curative benefit, a multidisciplinary team-including cardiology, oncology, and pharmacy-assessed the risks and benefits of continuing therapy. With close surveillance and optimized medical management, including anti-ischemic therapy and anticoagulation, cisplatin was safely reintroduced.

Cisplatin-induced myocardial infarction requires prompt recognition and coordinated care. With multidisciplinary evaluation, rechallenge can be safely performed in select patients.