Acute Coronary Syndrome Following Long-Term Erlotinib Treatment

Introduction. The treatment of neoplasia has advanced due to targeted molecular therapies. Erlotinib, a tyrosine kinase inhibitor that acts by blocking epidermal growth factor receptor (EGFR), is used to treat advanced or metastatic chemotherapy-resistant non-small cell lung cancers (NSCLC).

Erlotinib is a safe and well tolerated medication. Although the most common adverse effects are cutaneous or gastrointestinal, its cardiotoxicity is an important topic in the treatment and follow-up of neoplastic patients.

Clinical case. A 76-year-old male patient with 40 Pack Year history of smoking that has quitted 20 years ago, was admitted in 2009 for night sweats, dry cough and weight loss. He is diagnosed with lung cancer in the right upper lobe (T4N2M1), with the histopathological diagnosis of clear cell adenocarcinoma. The patient performs radiotherapy and chemotherapy with 6 series of Gemcitabine and Cisplatin with partial response, followed by Erlotinib treatment with favorable progression with regression of tumor size.

In December 2017, he presents recurrent episodes of atypical angina lasting about 2 weeks. The electrocardiographic examination reveals ST segment elevation, with tall T waves and Q waves are present in the lower branches, associated with the increase of myocardial necrosis enzymes. Echocardiography highlights inferior hypokinesia with left ventricle ejection rate estimated at 45%. The patient has a favorable evolution during admission without recurrence of pain. Coronary angiography is performed at distance with evidence of vascular atherosclerotic lesions and the installation of active pharmacodynamic stents.

Discussions. Tyrosine kinase inhibitors may be the cause of acute coronary events both by affecting myocardiocytes following EGFR inhibition, but also by increasing atheromatic plaque instability and by prolonging theQT segment.

In conclusion a systemic cardiologic assessment of Erlotinib-treated patients may be recommended throughout the course of therapy.