Single dose regorafenib-induced hypertensive crisis.

Area of Science:

• Oncology
• Pharmacology
• Gastroenterology

Background:

• Gastrointestinal stromal tumors (GISTs) are rare gastrointestinal neoplasms.
• Regorafenib is a multikinase inhibitor used for advanced GISTs resistant to imatinib and sunitinib.
• Common adverse events of regorafenib include hypertension, hand-foot skin reactions, and diarrhea.

Observation:

• A normotensive 54-year-old male GIST patient experienced a hypertensive crisis and seizure after his first dose of regorafenib.
• Upon admission, his blood pressure was recorded at 240/140 mmHg.
• Intensive treatment with nitrate and nitroprusside normalized his blood pressure over five days.

Findings:

• This case report details the first instance of Grade IV hypertension, including hypertensive crisis and seizure, following a single dose of regorafenib.
• The patient's hypertension resolved after regorafenib discontinuation and did not recur.
• The findings suggest that severe hypertension may be an idiosyncratic adverse reaction to regorafenib, potentially unrelated to dosage.

Implications:

• Clinicians should be vigilant for severe hypertension as a potential idiosyncratic reaction to regorafenib, even after a single dose.
• This case highlights the need for careful patient monitoring, especially during the initial phase of regorafenib treatment.
• Further research may be warranted to understand the mechanisms behind idiosyncratic reactions to regorafenib and identify at-risk patients.