Osimertinib
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Ejection fraction reduction and heart failure: case report A 73-year-old woman developed heart failure and had decreased ejection fraction during treatment with osimertinib for lung cancer. The woman, who was diagnosed with stage IV epidermal growth factor receptor (EGFR) gene mutation-positive lung cancer, started receiving treatment with oral osimeltinib 80mg daily as a second-line therapy. Previously, she received first line therapy with gefitinib. Subsequently, she experienced worsening of dyspnoea on exertion and the pleural fluid level had increased. Based on these clinical presentation, it was suspected that the lung cancer had recurred. Therefore, she was hospitalised for a complete examination. Laboratory investigations revealed body temperature of 36.4°C, pulse 81 /min/regular, BP 115/74mm Hg, breathing rate 20 /min, oxygen saturation (SpO2) 92% (room air) and increased brain natriuretic peptide level. A chest X-ray revealed pleural fluid retention and heart enlargement with right dominance compared to chest X-ray performed 2 months earlier. A simple chest simple CT showed bilateral pleural fluid with right dominance and cardiac enlargement, which was suspected as heart failure. An echocardiogram revealed that the contractile ability of the left ventricle had reduced circumferentially, and enlargement of left ventricle was observed. Also, her cardiac ejection fraction decreased significantly to 19%. Based on these findings and clinical presnatation it was confirmed that she developed heart failure and had decreased ejection fraction associated with osimertinib [duration of treatment to reactions onset not stated]. The woman’s treatment with osimertinib was discontinued, and she was treated with furosemide. Her respiratory condition improved on day 3 of illness, and a simple chest X-ray showed decrease in pleural fluid. On the day 15 of illness, a coronary catheter examination was performed because improvement was seen in the signs of heart failure when bisoprolol was used along with furosemide. No significant stenosis lesion was noted. On day 16 of illness, she was discharged from the hospital. Ito S, et al. [A Case of Significant Ejection Fraction Reduction and Heart Failure Induced by Osimertinib]. [Japanese]. Gan to Kagaku Ryoho 47: 609-613, No. 4, 2020. 803497052 Available from: URL: http://www.pieronline.jp/content/article/0385-0684/47040/609 [Japanese; summarised from a translation]
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Reactions 22 Aug 2020 No. 1818
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