CASE REPORT article
Front. Oncol.
Sec. Cardio-Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1615472
Sorafenib-to-Regorafenib Sequence-Induced Atherosclerotic Cardiovascular Disease: A Novel Case Report
Provisionally accepted- The Affiliated Hospital of Qingdao University, Qingdao, China
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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.
Keywords: tyrosine kinase inhibitors, Sorafenib, Regorafenib, Hepatocellular Carcinoma, Atherosclerotic cardiovascular disease, Drug-related toxicity
Received: 21 Apr 2025; Accepted: 07 Aug 2025.
Copyright: © 2025 Ji, Xu, Quan, Guo, Liu, Lu, Yang, Xu, Jin and Qu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hongyan Ji, The Affiliated Hospital of Qingdao University, Qingdao, China
Haijun Qu, The Affiliated Hospital of Qingdao University, Qingdao, China
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