Naib T, Steingart R M, Chen C L
Division of Cardiology, Memorial Sloan-Kettering Cancer Center, New York, USA.
Herz. 2011 Jun;36(4):348-51. doi: 10.1007/s00059-011-3444-5.
Cardiotoxicity associated with cancer treatment is an important field of interest especially as the new class of VEGF signaling pathway inhibitors (VSP) continues to grow. Small molecule tyrosine kinase inhibitors such as sorafenib, sunitinib, and pazopanib inhibit the downstream pathways of all three of the vascular endothelial growth factor receptors (VEGFR 1, 2, and 3). Other targets of these agents include kinases involved in vascular and myocardial homoeostasis. These agents are all known to frequently cause hypertension, their most common side-effect. Myocardial ischemia has also been reported, but the frequency and etiology of VSP-related ischemia is poorly characterized. This manuscript describes the first reported case of sorafenib-associated multivessel coronary vasospasm in a 57-year-old patient with hepatocellular carcinoma. He underwent sorafenib treatment, a tyrosinase inhibitor, 400 mg twice a day. The vasospasm was reversible under nitroglycerin. Possible mechanisms are also discussed.
与癌症治疗相关的心脏毒性是一个重要的研究领域，尤其是随着新型血管内皮生长因子信号通路抑制剂（VSP）的不断涌现。小分子酪氨酸激酶抑制剂，如索拉非尼、舒尼替尼和帕唑帕尼，可抑制所有三种血管内皮生长因子受体（VEGFR 1、2和3）的下游通路。这些药物的其他靶点包括参与血管和心肌稳态的激酶。众所周知，这些药物经常导致高血压，这是它们最常见的副作用。也有心肌缺血的报道，但VSP相关缺血的发生率和病因尚不明确。本文描述了首例57岁肝细胞癌患者使用索拉非尼后出现多支冠状动脉痉挛的病例。他接受了酪氨酸酶抑制剂索拉非尼治疗，每天两次，每次400毫克。在硝酸甘油作用下，血管痉挛是可逆的。文中还讨论了可能的机制。
