Xu Changli, Quan Xianghua, Guo Qie, Liu Donghua, Lu Cheng, Yang Xue, Xu Wen, Jin Fanbo, Qu Haijun, Ji Hongyan
Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Front Oncol. 2025 Aug 27;15:1615472. doi: 10.3389/fonc.2025.1615472. eCollection 2025.
This case report describes a 59-year-old male with HBV-associated hepatocellular carcinoma who developed progressive atherosclerotic cardiovascular disease (ASCVD) during sequential treatment with sorafenib and regorafenib. Initial sorafenib therapy (400 mg twice daily) led to hand-foot syndrome, necessitating dose reduction, and subsequently resulted in the onset of hypertension (152/92 mmHg), proteinuria (3+), and microscopic hematuria (2+). Due to disease progression, the patient was transitioned to regorafenib (160 mg daily), during which time he experienced worsening vascular toxicity manifested as lower extremity arterial occlusion, non-ST elevation myocardial infarction, and cerebral ischemia. Angiography revealed critical multivessel coronary disease (95-99% left anterior descending artery [LAD] stenosis) and complete femoropopliteal occlusion, requiring revascularization procedures. Notably, these severe ASCVD manifestations occurred despite a low baseline cardiovascular risk (10-year ASCVD risk of 4.5%) and the absence of traditional risk factors, underscoring the cumulative atherogenic effects of sequential vascular endothelial growth factor (VEGF) pathway inhibition. This case highlights the importance of continuous cardiovascular monitoring during tyrosine kinase inhibitor therapy, particularly when transitioning between agents.
本病例报告描述了一名59岁的男性，患有乙肝相关肝细胞癌，在接受索拉非尼和瑞戈非尼序贯治疗期间发生了进展性动脉粥样硬化性心血管疾病（ASCVD）。初始索拉非尼治疗（每日两次，每次400mg）导致手足综合征，需要降低剂量，随后引发高血压（152/92mmHg）、蛋白尿（3+）和镜下血尿（2+）。由于疾病进展，患者转而接受瑞戈非尼治疗（每日160mg），在此期间，他经历了血管毒性恶化，表现为下肢动脉闭塞、非ST段抬高型心肌梗死和脑缺血。血管造影显示严重的多支冠状动脉疾病（左前降支动脉[LAD]狭窄95-99%）和股腘动脉完全闭塞，需要进行血管重建手术。值得注意的是，尽管基线心血管风险较低（10年ASCVD风险为4.5%）且不存在传统风险因素，但仍出现了这些严重的ASCVD表现，这突出了序贯血管内皮生长因子（VEGF）通路抑制的累积致动脉粥样硬化作用。本病例强调了在酪氨酸激酶抑制剂治疗期间持续进行心血管监测的重要性，尤其是在更换药物时。
