Etoposide-induced angina in a patient with small cell lung carcinoma: a case report

The combination of cisplatin and etoposide is a standard therapy for small cell lung cancer; however, ischemic heart disease is a known complication. We report a rare case of effort angina pectoris that worsened during initial treatment of small cell lung cancer with etoposide. A 73-year-old Asian male was admitted to our hospital with effort angina. Coronary angiography revealed severe stenosis with significant calcification of the proximal right coronary artery. Computed tomography revealed a 21-mm-sized nodule in the right upper lobe and hilar lymphadenopathy suggestive of lung cancer. The patient underwent thoracoscopic wedge resection before coronary revascularization, and intraoperative findings indicated a small cell carcinoma with hilar lymph node metastases. Early postoperative definitive treatment consisting of chemotherapy with cisplatin plus etoposide and accelerated hyperfractionated radiation was planned. During the first chemotherapy session, on postoperative day 7, the patient complained of chest pain, and an electrocardiogram showed slight ST depression in leads V5 and V6 while receiving etoposide; nitroglycerin improved his symptoms. Although treatment was resumed with the administration of nicorandil the next day, the same symptoms were observed during the infusion of etoposide. Accordingly, chemoradiation therapy was suspended and revascularization of the right coronary artery was performed. Etoposide and cisplatin were readministered 3 days after revascularization, without any chest symptoms. Chemotherapy for malignant tumors carries the risk of progression to coronary artery disease. To prevent serious ischemic events, sufficient discussions between oncologists and cardiologists and careful observation of chest symptoms are needed.