371 Cardiac Dysfunction Secondary to Neoadjuvant FLOT Chemotherapy for Oesophagogastric Cancer: A Case Series

Abstract Curative management for oesophagogastric adenocarcinoma traditionally involves four cycles of neo-adjuvant chemotherapy, FLOT (fluorouracil, leucovorin, oxaliplatin and docetaxel) followed by surgery and four cycles of adjuvant FLOT. Chemotherapy aims to reduce tumour bulk and prevent recurrence. Chemotherapy agents, especially fluorouracil, are known to cause cardiotoxicity which subsequently can impact cardiac function. We discuss three cases of cardiac dysfunction during neoadjuvant chemotherapy for patients diagnosed with oesophagogastric cancer. The first patient (56M) presented with chest pain following their first cycle of FLOT for oesophageal cancer, presumed squamous cell carcinoma. Echocardiogram showed severely impaired left ventricular (LV) function (ejection fraction of 35%). Chemotherapy was stopped. He was listed for surgery after a cardiac MRI showed a full recovery in his LV function however the tumour was too advanced and not resectable. The second patient (64F) had completed her neoadjuvant FLOT for oesophageal adenocarcinoma. Pre-operative echocardiogram showed a mildly dilated left ventricle with severe systolic dysfunction (estimated ejection fraction 25-30%) and deemed not fit for surgery. She received palliative radiotherapy during which her LV function improved and went on to have an oesophagectomy. The third patient (65M), diagnosed with a gastric adenocarcinoma, suffered an NSTEMI following their third-cycle of FLOT. A cardiac MRI revealed hypertrophic cardiomyopathy. He underwent a gastrectomy although did not have any adjuvant chemotherapy due to the cardiac risk. He subsequently had a recurrence within one-year of surgery. Our cases demonstrate the importance of cardiac monitoring during chemotherapy for these patients and highlights the significant impact when chemotherapy is disrupted.