The use of quadrotherapy of chronic heart failure in cancer patients (case series)

Background: Chronic heart failure (CHF) for a patient with cancer is complex, as it complicates antitumor treatment. In some cases, severe CHF is a contraindication to the chemotherapy or surgical treatment. Despite significant progress in CHF treatment, some groups of drugs, particularly mineralocorticoid receptor inhibitors, angiotensin receptor-neprilysin inhibitors, and sodium-glucose co-transporter type 2 inhibitors, have not been studied related to cancer patients.

Clinical case description: In this report, we introduce two clinical cases in which, because of the invaluable contribution of the cardio-oncological team, we have managed to solve complex problems of treating patients with CHF and cancer. In patient 1 with severe CHF, it was possible to achieve regression of systolic dysfunction, despite the progression of bladder cancer T4N1M0. In patient 2 with severe ischemic cardiopathy and CHF, owing to the timely administration of quadruple therapy, we managed to significantly improve the cardiac status and increase the LV EF that the patient underwent gastrectomy and cholecystectomy for cancer of the cardiac part of the stomach cT2N0M0 without complications.

Conclusion: The above clinical cases demonstrate the possibilities of a team, multidisciplinary approach in the treatment of complex category of patients with CHF and active oncological disease. Modern therapy of cancer patients with severe heart failure allows successful antitumor treatment.