Tako-Tsubo syndrome after alectinib initiation

Introduction: Tako-Tsubo syndrome (TTS) is a rare but potentially serious condition of non-ischemic left ventricular dysfunction, often reversible. Alectinib, an anaplastic lymphoma kinase (ALK) inhibitor commonly used for patients with metastatic ALK-rearranged non-small cell lung cancer, has been linked mainly to EKG disturbances like bradycardia or prolonged QT interval, but TTS is underreported. Case presentation: We present a TTS in a post-menopausal woman initiating alectinib in whom classical TTS regional motion disturbances of the left ventricle after suffering a syncope were diagnosed. Discussion: This clinical case represents the first documented TTS directly related to alectinib treatment. Although isolated cases have been reported in pharmacovigilance sources, typical TTS in a patient under recent initiation of alectinib has not been previously documented. TTS represents a rare expression of cancer treatment-related cardiac disfunction with no unequivocal predisposing factors. Conclusion: Severely depressed left ventricular ejection fraction presented a total recovery after heart failure treatment what allowed successful resume of alectinib with dose escalation under Cardio-oncology monitoring.