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

Sep 28, 2026

Report of a 56-year-old male with metastatic non-small cell lung cancer treated with entrectinib 600 mg daily for five years who developed acute chest pain with transient ST-segment elevation and troponin rise during alcohol intoxication. Coronary angiography, transthoracic echocardiography, and cardiac MRI were unremarkable. ST elevation resolved after withholding entrectinib for two days. Given no alternative cause, entrectinib was suspected, and therapy was restarted at 400 mg daily after three weeks. Mechanism is unclear, and heavy alcohol intake may contribute; further research is required to clarify long-term cardiac toxicity and drug–alcohol interactions.

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Review began 11/16/2025 Review ended 11/30/2025 Published 12/02/2025 © Copyright 2025 Xia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98345 Open Access Case Report 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 Chenfan Xia 1, Suzanne Kosmider 1 1. Department of Oncology, Western Health, Melbourne, AUS Corresponding author: Chenfan Xia, [chenfan.xia@icloud.com](chenfan.xia@icloud.com) Abstract 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. Categories: Cardiology, Substance Use and Addiction, Oncology Keywords: alcohol-related disorder, cancer treatment side effects, cardiac arrhythmia, entrectinib, non-small cell lung carcinoma (nsclc), ros1 gene fusion, ros1-positive nsclc, st elevation ecg, targeted therapy, tyrosine kinase inhibitor (tki) Introduction ROS proto-oncogene 1 (ROS1 gene) fusions are present in various tumour types, including 1% to 2% of nonsmall cell lung cancer (NSCLC) [1] . The resulting oncoprotein causes continuous kinase activation and downstream signalling, and leads to tumour growth [2] . It is more common in younger individuals, females, and non-smokers. Entrectinib is a tyrosine kinase inhibitor that has been used for treating ROS1 fusionpositive NSCLC, demonstrating significant systemic and intracranial efficacy, along with prolonged survival benefit [1] . However, there have also been reports of serious treatment-related adverse events. For example, 2% of patients developed cardiac disorders, including QT prolongation, myocarditis, and cardiac failure [2] . There are also case reports of entrectinib-associated ST elevation. The exact mechanism is not yet fully understood, but it may be due to dysfunction of iron channels [3] . This report describes a case of a 56-year-old male with NSCLC who had been on entrectinib 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 (MRI), which were all unremarkable. The ST elevation resolved after withholding entrectinib for two days, and no other cause was identified, suggesting that entrectinib may be the potential cause. It is also unclear why this event occurred after five years of treatment and whether alcohol consumption was a contributing factor. This late onset of ST elevation after such a prolonged treatment duration has not been reported

FAQs

What clinical event occurred in this patient during alcohol intoxication?

He developed acute central chest pain with transient ST elevation and troponin rise, along with new wide QRS complexes suggesting ST elevation myocardial infarction.

What tests were performed to evaluate cardiac causes?

Coronary artery angiogram, transthoracic echocardiogram, and cardiac magnetic resonance imaging were performed and were unremarkable.

How did the patient’s ECG findings change after stopping and restarting entrectinib?

ST elevation resolved after withholding entrectinib for two days. Because no other cause was identified, entrectinib was recommenced at a reduced dose of 400 mg daily after withholding it for three weeks.

Sep 28, 2026

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