Neurogenic orthostatic hypotension after treatment with sorafenib

Area of Science:

• Oncology
• Pharmacology
• Autonomic Neuroscience

Background:

• Desmoid tumors are rare, locally aggressive neoplasms.
• Sorafenib is a multi-kinase inhibitor used to treat various cancers.
• Vascular Endothelial Growth Factor (VEGF) inhibitors can have diverse side effects.

Observation:

• A 70-year-old male with a peritoneal desmoid tumor was treated with sorafenib.
• The patient subsequently developed exertional dyspnea, lower extremity weakness, supine hypertension, and orthostatic hypotension.
• Autonomic testing revealed impaired sympathetic responses and marked orthostatic hypotension.

Findings:

• Sorafenib treatment was associated with the onset of severe orthostatic hypotension.
• The patient experienced modest symptom improvement after sorafenib discontinuation and supportive care.
• This case represents the first documented instance of sorafenib-induced orthostatic hypotension.

Implications:

• Clinicians should be vigilant for autonomic dysfunction, specifically orthostatic hypotension, in patients treated with sorafenib.
• This finding expands the known side effect profile of vascular endothelial growth factor inhibitors.
• Further research is warranted to elucidate the mechanism of sorafenib-induced autonomic dysfunction.