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A case of variant angina in a patient under chronic treatment with sorafenib

Nature Reviews Clinical Oncology volume 7, pages 476–480 (2010)Cite this article

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Abstract

Background. A 63-year-old man with an unresectable multifocal hepatocellular carcinoma (HCC) presented with upper abdominal discomfort, nausea and vomiting. We report a case of variant angina in a patient affected by unresectable HCC under chronic treatment with sorafenib. Spontaneous spasm occurred during cardiac catheterization and was revealed during coronary angiogram with the unusual feature of a retrograde transient filling of a contralateral branch.

Investigations. Electrocardiogram, cardiac catheterization, chest X-ray, emergency ECG.

Diagnosis. Variant angina induced by sorafenib treatment mimicking infero-posterior ST-elevation myocardial infarction (STEMI).

Management. High-dose calcium-antagonists and nitrates were initially given intravenously and then orally. Sorafenib therapy was then resumed without further symptoms. Restaging of the cancer revealed unexpected local recurrence and the patient died 1 month after receiving palliative care. We contend that the effects of sorafenib treatment were primarily responsible for the major cardiovascular event observed in this case, and it is important for clinicians to be aware of this possible severe complication of sorafenib therapy.

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Figure 1: ECG performed during chest pain showed 2 mm ST elevations in the inferior leads with lesser elevations in the lateral leads, with a specular anterolateral ST depression and a high R-wave in V2–V3.
Figure 2: ECG and angiography after resolution of angina.
Figure 3: ECG and angiography during and after recurrence of angina.
Figure 4: Possible mechanisms of sorafenib-mediated vasospastic angina.14

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito 1, Rome, 00168, Italy

    Italo Porto, Andrea Leo & Filippo Crea

  2. Department of Internal Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito 1, Rome, 00168, Italy

    Luca Miele, Maurizio Pompili & Raffaele Landolfi

Authors
  1. Italo Porto
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Correspondence to Italo Porto.

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Porto, I., Leo, A., Miele, L. et al. A case of variant angina in a patient under chronic treatment with sorafenib. Nat Rev Clin Oncol 7, 476–480 (2010). https://doi.org/10.1038/nrclinonc.2010.67

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