Late Onset of Entrectinib-Related ST Elevation in the Setting of Alcohol Intoxication in a Patient With Metastatic Non-small Cell Lung Cancer: A Case Report and Literature Review

This report describes a case of a 56-year-old male with non-small cell lung cancer who had been on entrectinib 600 mg daily for five years. He presented with an acute onset of chest pain associated with transient ST elevation and troponin rise in the context of alcohol intoxication. He was investigated with a coronary artery angiogram, a transthoracic echocardiogram, and a cardiac magnetic resonance imaging, which were all unremarkable. The ST elevation resolved after withholding entrectinib for two days. Given that no other cause was identified, it suggests that entrectinib may be the potential cause. Considering the patient's good response to entrectinib in the past, we recommenced entrectinib at a reduced dose of 400 mg daily after withholding it for three weeks. This late onset of ECG changes after such a prolonged treatment duration has not been reported previously, and the underlying mechanism remains unclear. It is also uncertain whether heavy alcohol intake is a contributing factor. Further research is needed to investigate the long-term cardiac toxicity of entrectinib and the potential interactions between entrectinib and alcohol.