Sorafenib-induced acute myocardial infarction due to coronary artery spasm.
A 65-year-old man with advanced renal cell carcinoma was admitted due to continuing chest pain at rest. Two weeks before his admission, sorafenib had been started. He was diagnosed with non-ST-elevation myocardial infarction by laboratory data and electrocardiogram. Enhanced heart magnetic resonance imaging also showed subendocardial infarction. However, there was no stenosis in coronary arteries on angiography. Coronary artery spasm was induced by a provocative test. Cessation of sorafenib and administration of Ca-channel blocker and nitrates ameliorated his symptoms, but relapse occurred after resumption of sorafenib. Addition of oral nicorandil reduced his symptoms and maintained stable angina status. We report the first case of sorafenib-induced coronary artery spasm. Sorafenib is a multikinase inhibitor that targets signaling pathways necessary for cellular proliferation and survival. On the other hand, the Rho/ROCK pathway has an important role in the pathogenesis of coronary artery spasm. Our report may show an adverse effect on the Rho/ROCK pathway by sorafenib use.
Arima
Yuichiro
Y
Division of Cardiology, Kumamoto Central Hospital, Kumamoto, 1-5-1 Tainoshima, Kumamoto City 862-0965, Japan.
Oshima
Shuichi
S
Noda
Katsuo
K
Fukushima
Hironobu
H
Taniguchi
Izumi
I
Nakamura
Shinichi
S
Shono
Makoto
M
Ogawa
Hisao
H
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001557:Benzenesulfonates / Q000009:adverse effects*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D011725:Pyridines / Q000009:adverse effects*; D015398:Signal Transduction / Q000502:physiology; D000077157:Sorafenib; D054460:rho-Associated Kinases / Q000502:physiology; D020742:rhoA GTP-Binding Protein / Q000502:physiology
D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib; D054460:rho-Associated Kinases; D020742:rhoA GTP-Binding Protein