Pantaleo et al. BMC Cancer 2012, 12:231 http://www.biomedcentral.com/1471-2407/12/231 Page 4 of 5 Table 2 Descriptions of the three reported cases which developed coronary artery disease during sorafenib treatment Reference Naib T et al. [9] Case 57 years-old patient Arima Y et al. [10] 65 years-old patient Porto I et al. [11] 63 years-old patient Disease HCC mRCC HCC Types of events multiple coronary vasospasm coronary artery spasm Cardiovascolar risck factors history of diabetes, hyperlipidemia, former tobacco use arterial hypertension variant angina for spontaneous coronary spasm history of diabetes and arterial hypertension, Coronarography Normal Normal Normal time it would take for such lesions to develop in a 58-year old man without cardiovascular risk factors. The risks of cardiac ischemia/infarction during treatment with angio- genesis inhibitors or TKIs are reported to be very low (1.5 % for bevacizumab, <1 % for sunitinib, 2.9 % for sora- fenib) [6,18,23]. These events are usually associated with the presence of cardiovascular risk factors, but few detailed data on coronary angiography findings have been reported. Coronary angiography was performed and found to be normal in 7 of 74 patients with symptomatic cardiac events [18]. The frequency of treatment for acute cardiac ischemia was reported to be higher in patients receiving sorafenib (2.9 %) than patients receiving placebo (0.4 %), with an overall low rate of acute cardiac events during a median follow-up time of 16 months [5,13]. In the Advanced RCC Sorafenib (ARCCS) expanded access pro- gram, ATE events, including cardiac ischemia, were not reported [4]. Three cases of coronary artery disease related to sorafenib therapy have been described in the literature, which were all due to arterial vasospasm without evidence of coronary artery stenosis on angiography, and were all associated with cardiovascular risk factors [9–11]. Details of these three cases are presented in Table 2. The case presented here indicates that attention should be paid to the potential occurrence of occlusive coronary artery disease during treatment with TKIs, and that patients should be carefully monitored for the development of symptoms of coronary ischemia/ infarction. Even though cardiotoxicity is widely reported and recognized as an important though not frequent toxic effect of treatment with sunitinib and other tumor angio- genesis inhibitors, there is currently no consensus regard- ing the prevention and management of these side effects. Conclusions In conclusion, we have presented a brief overview of the available data on cardiovascular events in patients treated with TKIs, and of the potential for the development of oc- clusive coronary artery disease. Understanding the useful- ness of careful cardiovascular monitoring might be important to prevent fatal cardiovascular events and avoid discontinuation of treatment for the underlying cancer. Consent The patient has given consent for the publication of this report. Competing interests The authors declare that they have no competing interests. Author details 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. 3Laboratorio di Emodinamica, Struttura Complessa di Cardiologia (Direttore Dr Angelo Ramondo), Ospedale S. Bassiano, Bassano del Grappa, Verona, Italy. 4University of Bologna, Department of Hematology and Oncological Sciences "L.A. Seragnoli", S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy. Authors’ contributions Pantaleo MA and Mandrioli A analyzed the data and drafted the manuscript. Saponara M, Nannini M, and Lolli C drafted the manuscript. Erente G analyzed the data. Biasco G critically revised the manuscript. All authors read and approved the final manuscript. 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