Aortic dissection in a patient treated with anlotinib for metastatic lung squamous cell carcinoma

Abstract

Anlotinib is an anti-angiogenic drug that targets vascular endothelial growth factor receptor, platelet-derived growth factor receptor, fibroblast growth factor receptor, c-Kit, and other kinases and has been approved for the treatment of advanced non-small cell lung cancer (NSCLC). As in other small-molecule tyrosine kinase inhibitors, adverse effects such as hypertension and cardiotoxicity may be seen. However, the relationship between anlotinib and aortic dissection has not been previously reported. Here, we present a case of aortic dissection in a 58-year-old male patient with advanced NSCLC without history of hypertension who received anlotinib as third-line treatment. After four courses of anlotinib treatment, he suffered a sudden onset of back pain, sweating, anxiety, and high blood pressure (180/120 mmHg) and heart rate (137 bpm). Emergency computed tomographic angiography revealed aortic dissection and thrombosis of the distal false lumen. Thereafter, the patient was administered nitroglycerin as antihypertensive treatment and he underwent stent-graft intervention for aortic dissection. Anticoagulants and antihypertensive drugs were administered after the operation, and a moderate control of blood pressure was achieved. Thus, the adverse reactions of antolinib must be monitored and clinicians must be vigilant.

Posterior Reversible Encephalopathy Syndrome Associated With Anlotinib: A Case Report and Literature Review

“…Hence, anlotinib induced endothelial dysfunction and hypertension in our patient, who had no history of hypertension, may both contributed to PRES. Accordingly, in reviewed cases, we found that anlotinib occasionally increase blood pressure in those who had no history of hypertension, which simultaneously happened with vascular involved adverse effects ( 6 , 8 , 10 ). Discontinuation of anlotinib and anti-hypertensive drug could control increased blood pressure.…”

“…A study reporting the phase I clinical trial outcomes for this drug found that the safety dosage is 12 mg/day (4) and that the most common adverse effects related to nervous system disorder was reported to be dizziness and headache in the ALTER0303 trial (5). In addition, there are a few rare adverse effects reported (6)(7)(8)(9)(10). Though there have been cases of PRES induced by other VEGF inhibitors, anlotinib has not been previously reported to be associated with PRES (11)(12)(13).…”

In vitro studies of H520 cell cycle and apoptosis by anlotinib combined with radiotherapy

“…Anlotinib is a novel small molecule, multitargeted tyrosine kinase inhibitor that is currently included in clinical trials for a variety of cancers. Its targets of action include significant inhibitory activity against angiogenesis‐related kinases such as VEGFR1/2/3, FGFR1/2/3 and other tumor‐associated kinases such as PDGFR, c‐Kit and Ret that are associated with cell proliferation; other partial kinase targets under malignant investigation include Aurora‐B, c‐FMS, and DDR1, and partial kinase mutants, such as PDGFR , c‐Kit , Met , and EGFR , and the inhibitory activity of anlotinib against partial mutants has been found to be even stronger than that of wild‐type 7–9 . The probability of EGFR ‐sensitive mutations in Chinese patients with advanced lung adenocarcinoma is about 50%.…”

Aortic dissection induced by vascular endothelial growth factor inhibitors

“…The review of the literature identified seventeen eligible case reports with VEGFI related to AD (Aragon-Ching et al, 2008;Edeline et al, 2009;Carles, 2010;Formiga and Fanelli, 2014;Kurtz et al, 2014;Niwa et al, 2015;Koda et al, 2016;Hatem et al, 2017;Xu et al, 2017;Atsunori et al, 2018;Takada et al, 2018;Toru et al, 2018;Fubo and Gong, 2019;Zenoni et al, 2019;Jiang et al, 2020;Nikai et al, 2020;Ting and Lo, 2021). Thirteen of the seventeen patients are male, and four patients are female.…”