Pantaleo et al. BMC Cancer 2012, 12:231 http://www.biomedcentral.com/1471-2407/12/231 C A S E R E P O R T Open Access Development of coronary artery stenosis in a patient with metastatic renal cell carcinoma treated with sorafenib Maria Abbondanza Pantaleo1,2,4*, Anna Mandrioli1, Maristella Saponara1, Margherita Nannini1, Giovanna Erente3, Cristian Lolli1 and Guido Biasco1,2 Abstract Background: Tyrosine kinase inhibitors (TKIs) are currently approved for the treatment of metastatic renal cell carcinoma (mRCC). The cardiotoxic effects of sorafenib and sunitinib may cause hypertension, left ventricular ejection fraction (LVEF) dysfunction and/or congestive heart failure (CHF), and arterial thrombo-embolic events (ATE). Only three cases of coronary artery disease related to sorafenib therapy have been described in the literature, and all were due to arterial vasospasm without evidence of coronary artery stenosis on angiography. Cardiotoxicity is commonly associated with the presence of cardiovascular risk factors, such as a history of hypertension or coronary artery disease. Case presentation: We describe a patient who experienced an unusual cardiac event after 2 years of sorafenib treatment. A 58-year-old man with mRCC developed acute coronary syndrome (ischemia/infarction) associated with critical sub-occlusion of the common trunk of the left coronary artery and some of its branches, which was documented on coronary angiography. The patient underwent triple coronary artery bypass surgery, and sorafenib treatment was discontinued. He did not have any cardiovascular risk factors, and his cardiac function and morphology were normal prior to sorafenib treatment. Conclusions: Further investigation of a larger patient population is needed to better understand cardiac damage due to TKI treatment. Understanding the usefulness of careful cardiovascular monitoring might be important for the prevention of fatal cardiovascular events, and to avoid discontinuation of therapy for the underlying cancer. Keywords: Sorafenib, renal cell carcinoma, coronary syndrome, cardiotoxicity, cardiac ischemia/infarction Background Tyrosine kinase inhibitors (TKIs) are currently approved for the treatment of metastatic renal cell carcinoma (mRCC) [1,2]. Common toxicities due to sorafenib and sunitinib treatment include reversible skin rashes, hand- foot skin reaction, diarrhea, hypertension, hemorrhage, and laboratory findings such as leucopenia, hypophospha- temia, elevated pancreatic enzymes levels, and proteinuria [3,4]. Other clinical events related to cardiotoxicity include left ventricular ejection fraction (LVEF) dysfunction and/ or congestive heart failure (CHF) and arterial thrombo- * Correspondence: maria.pantaleo@unibo.it 1Department of Hematology and Oncological Sciences “L&A Seràgnoli”, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy 2“Giorgio Prodi” Cancer Research Center, University of Bologna, Bologna, Italy Full list of author information is available at the end of the article embolic events (ATE) [3–8]. Several authors have con- cluded that LVEF dysfunction and/or CHF is more fre- quent in patients with a history of hypertension or coronary artery disease. Only three cases of coronary ar- tery disease related to sorafenib treatment have been described in the literature. All three cases were associated with the presence of cardiovascular risk factors and were due to arterial vasospasm without evidence of coronary ar- tery stenosis on angiography [9–11]. Case presentation In 2007, a 58-year-old white male with no history of tobacco use, hypertension, diabetes, or hypercholesterol- emia, and no family history of coronary artery disease, was found to have a large solid right renal mass and © 2012 Haltas et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.