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To the Editor:Cancer and cardiovascular disease constitute the two major causes of death worldwide.Whereas the incidence of cancer increases among adults up to 74 years of age,above this age the cardiovascular disease surpasses cancer as the primary cause of mortality.[1] Currently,chemotherapy,radiation therapy,and surgery are the main modalities for the treatment of cancer.However,chemotherapy can induce cardiovascular worsening,manifesting as acute and chronic symptomatology.Therefore,the very interesting report published in Chinese Medical Joal[2] concing a 60-year-old male patient suffering from coronary artery disease and squamous cell carcinoma of the left lung who developed an ST segment elevation myocardial infarction following treatment with afatinib (tyrosine kinase inhibitor) and gemcitabine (antimetabolite pyrimidine antagonist) and cisplatin (platinum based DNA replication inhibitor) and the subsequent discussion raise several important considerations on cardiac toxicity,cardiac hypersensitivity and the Kounis-hypersensitivity acute coronary syndrome.