Acute Aortic Dissection in a Patient Receiving Multiple Tyrosine Kinase Inhibitors for 5 Years

Abstract

A 48-year-old male presented with para-aortic lymph node metastases after surgical resection of a clear cell renal cell carcinoma. After first-line treatment with interferon alpha-2b, he was started on pazopanib and lapatinib. Blood pressure was well controlled with temocapril and amlodipine. Treatment had to be stopped 4 years and 8 months after initiation due to overt proteinuria. Then, sunitinib was started as third-line treatment. During the second cycle of sunitinib, he died due to a Stanford type A aortic dissection. Acute aortic dissection could be an adverse event associated with the long-term use of antiangiogenic tyrosine kinase inhibitors.

Zusammenfassung

Ein 48jähriger Mann stellte sich mit paraaortalen Lymphknotenmetastasen nach chirurgischer Resektion eines Klarzellkarzinoms vor. Nach First-Line-Therapie mit Interferon Alpha-2b wurde eine Therapie mit Pazopanib und Lapatinib begonnen. Der Blutdruck zeigte unter Temocapril und Amlodipin gut kontrollierte Werte. Die Therapie musste nach 4 Jahren und 8 Monaten wegen offenkundiger Proteinurie beendet werden. Daraufhin wurde Sunitinib als Third-Line-Therapie begonnen. Während des zweiten Sunitinib Zyklus, starb der Patient aufgrund einer Stanford-A-Dissektion. Akute Aortendissektionen könnten ein unerwünschtes Ereignis bei Langzeittherapie mit anti-angiogenetischen Tyrosinkinase-Hemmern sein.

Key words

aortic dissection - pazopanib - sunitinib - multiple tyrosine kinase inhibitors - renal cell carcinoma

Schlüsselwörter

Aortendissektion - Pazopanib - Sunitinib - Multiple Tyrosinkinease-Inhibitoren - Klarzellkarzinom

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