J Liver Cancer.  2020 Mar;20(1):67-71. 10.17998/jlc.20.1.67.

Recurrent Coronary Artery Vasospasm in a Patient with Hepatocellular Carcinoma Treated with Sorafenib: a Case Report and Literature Review

• Lim DH
• Yoon JH
• Jun DW
• Lee OY
• Yoon BC
• Lee HR
• Kim KS
• Choi HS

• KMID: 2505844
• DOI: http://doi.org/10.17998/jlc.20.1.67

Abstract

Tyrosine kinase inhibitors are widely used as targeted treatments for various malignancies. Sorafenib is an orally active tyrosine kinase inhibitor that blocks the signaling pathways of several growth factors. Its use is approved for various malignancies such as unresectable hepatocellular carcinoma, renal cell carcinoma, and gastrointestinal stromal tumors. Several adverse effects have been reported in the literature; however, cardiotoxicity is rare. We present a case of recurrent coronary vasospasm caused by short-term administration (5 days) of sorafenib. Since it caused refractory ischemia after re-administration, we had no choice but to stop the treatment.

Keyword

Sorafenib; Coronary artery vasospasm; Variant angina; Tyrosine kinase inhibitor; Vascular endothelial growth factor inhibitor

Figure

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  Figure 1. (A) Baseline electrocardiogram (ECG) obtained 2 months before symptom onset showing a normal sinus rhythm. (B) ECG at the time of presentation showing inverted T-wave in leads V1-V3 (arrows). aVR, augmented vector right; aVL, augmented vector left; aVF, augmented vector foot.

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  Figure 2. (A) After the provocation test (ergonovine injection), the middle of the left anterior descending artery, as well as the proximal left circumflex artery, have narrowed. (B) Following intracoronary nitroglycerin injection, the obstructed arteries have fully recovered. NTG, nitroglycerin.

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  Figure 3. Electrocardiogram (ECG) obtained when the symptom recurred. The ECG shows T-wave changes in the anteroseptal leads (V1-V4). aVR, augmented vector right; aVL, augmented vector left; aVF, augmented vector foot.

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