Reversible ST-T Segment Changes Induced by Anamorelin: A Case Report

Anamorelin has been approved for cancer cachexia in Japan. Anamorelin has been known to cause adverse events including QT prolongation and can lead to fatal arrhythmia. We report a first case of a male patient with non-small cell lung cancer who showed ST-T segment change following anamorelin. Five days after starting anamorelin, ST-segment elevation in lateral leads and reciprocal ST depression in the inferior leads were noted. He did not complain about chest pain. Neither echocardiography nor computed tomography angiography revealed abnormal findings. Anamorelin was immediately discontinued. ST-T segment change recovered gradually and returned to normal on Day 19. During the course, cardiac enzymes had never been elevated. The manufacturer reports that anamorelin is shown to weakly but competitively bind to calcium channel L-type receptors, which could inhibit repolarization. Even if patients do not complain of chest discomfort, an early ECG should be considered.