Bevacizumab-Related Microvascular Angina and Its Management with Nicorandil

Int Heart J. 2017 Oct 21;58(5):803-805. doi: 10.1536/ihj.16-537. Epub 2017 Sep 30.

Abstract

Bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF)-A, is currently used to treat patients with ovarian or colon cancer. While several cardiovascular toxicities related to bevacizumab-containing regimens have been reported, the effect of bevacizumab on the coronary microcirculation has not been fully elucidated. Here we report a case of 54-year-old female patient who developed microvascular angina after a series of bevacizumab-containing chemotherapeutic regimen. The discontinuation of bevacizumab and nicorandil administration was effective in alleviating her chest discomfort and the ischemic changes on her ECG. This highlights the possibility that coronary microvascular angina can be induced in patients treated with bevacizumab-containing chemotherapy. It should also be noted that nicorandil can be effective in managing microvascular angina.

Keywords: Avastin; Chemotherapy; VEGF.

Publication types

  • Case Reports

MeSH terms

  • Angiogenesis Inhibitors / adverse effects
  • Angiogenesis Inhibitors / therapeutic use
  • Bevacizumab / adverse effects*
  • Bevacizumab / therapeutic use
  • Coronary Angiography
  • Coronary Circulation / drug effects
  • Dose-Response Relationship, Drug
  • Electrocardiography / drug effects
  • Female
  • Follow-Up Studies
  • Humans
  • Microvascular Angina / chemically induced
  • Microvascular Angina / diagnosis
  • Microvascular Angina / drug therapy*
  • Middle Aged
  • Nicorandil / administration & dosage*
  • Ovarian Neoplasms / drug therapy
  • Vasodilator Agents / administration & dosage

Substances

  • Angiogenesis Inhibitors
  • Vasodilator Agents
  • Nicorandil
  • Bevacizumab