Osimertinib-induced cardiac failure with QT prolongation and torsade de pointes in a patient with advanced pulmonary ade
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CASE REPORT
Osimertinib‑induced cardiac failure with QT prolongation and torsade de pointes in a patient with advanced pulmonary adenocarcinoma Saori Ikebe1 · Ryohei Amiya2 · Seigo Minami1 · Shoichi Ihara1,3 · Yoshiharu Higuchi2 · Kiyoshi Komuta1,3 Received: 2 August 2020 / Accepted: 26 September 2020 © The Japan Society of Clinical Oncology 2020
Abstract Osimertinib-induced cardiotoxicity is a well-known but rare disorder. An 84-year-old woman was diagnosed with recurrence of lung adenocarcinoma showing an epidermal growth factor receptor mutation of exon 19 deletion, which was initially treated by curative-intent thoracic radiotherapy 4 years prior. She started taking osimertinib (80 mg/day). She had no history of heart disease and showed no signs of cardiac problems. However, 2 months later she presented with symptoms of cardiac failure and QT prolongation on electrocardiogram. Cardiac enzyme levels were not elevated and coronary computed tomography angiography showed no significant stenosis. On admission, sudden-onset torsade de pointes required electrocardioversion. Thus, drug-induced cardiac failure was strongly suspected and we stopped osimertinib therapy. Cardiac function and the electrocardiogram abnormality improved. To our knowledge, this is the third case of coincidence of cardiac failure and QT prolongation and the second case of sudden-onset torsade de pointes associated with osimertinib treatment. In our case, osimertinib-induced cardiac failure with QT prolongation was recovered by stopping the drug treatment. The potential for cardiotoxicity should be considered with osimertinib treatment. Keywords Osimertinib · Cardiac failure · QT prolongation · Torsade de pointes · Epidermal growth factor receptor (EGFR)
Introduction Osimertinib is a third-generation tyrosine kinase inhibitor (TKI) of epidermal growth factor receptor (EGFR) used for treatment of non-small cell lung cancer harboring an EGFR mutation. Cardiotoxicity is an infrequent but important adverse event (AE) of chemotherapeutic agent treatment. For example, osimertinib can cause QT prolongation. Furthermore, according to a US retrospective clinical study from 2016 to 2018, osimertinib significantly increased the risk of cardiotoxicity including cardiac failure, atrial fibrillation, Saori Ikebe and Ryohei Amiya contributed equally to this study. * Seigo Minami [email protected] 1
Department of Respiratory Medicine, Osaka Police Hospital, 10‑31 Kitayama‑cho, Tennoji‑ku, Osaka 543‑0035, Japan
2
Department of Cardiology, Osaka Police Hospital, 10‑31 Kitayama‑cho, Tennoji‑ku, Osaka 543‑0035, Japan
3
Department of Respiratory Medicine, Daini Osaka Police Hospital, 2‑6‑40 Karasuga‑tuji, Tennoji‑ku, Osaka 543‑0042, Japan
QT prolongation, myocardial infarction, and pericardial effusion compared with other EGFR-TKIs [1]. In that study, cardiac failure was the most common AE associated with osimertinib treatment, followed by QT prolongation. A Japanese single-center retrospective study of 123 patients treated with osimertinib
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