Successful Management of Osimertinib-Induced Heart Failure

Fukuo, Atsuko; Imamura, Teruhiko; Onoda, Hiroshi; Kinugawa, Koichiro

doi:10.3390/medicina58020312

Cited by 5 publications

(2 citation statements)

References 13 publications

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“…There are currently no established guidelines regarding treatment modification in the setting of osimertinib-induced cardiomyopathy, although cases of osimertinib re-challenge and/or dose reduction have also been reported [ 5 , 6 , 12 , 13 ]. We reasoned that osimertinib-induced cardiomyopathy might involve an off-target that was non-overlapping with earlier generation EGFR TKIs and therefore favored EGFR TKI substitution as a strategy to prevent re-emergence of adverse cardiac side-effects.…”

Section: Discussionmentioning

confidence: 99%

Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report

Patel,

Hsu,

Lou

et al. 2023

Cardio-Oncology

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Background Osimertinib is a third-generation epidermal growth factor receptor (EGFR) inhibitor that is currently the first-line treatment for metastatic EGFR-mutated non-small-cell lung cancer (NSCLC) due to its favorable efficacy and tolerability profile compared to previous generations of EGFR inhibitors. However, it can cause uncommon, yet serious, cardiovascular adverse effects. Case Presentation We present the case of a 63-year-old man with EGFR-mutated NSCLC treated with osimertinib who developed new-onset non-ischemic cardiomyopathy with biventricular dysfunction and heart failure in the context of an enlarging pericardial effusion. For the first time, we demonstrate cardiac MR imaging findings associated with osimertinib-associated cardiomyopathy, including focal late gadolinium enhancement and myocardial edema. The patient’s biventricular function normalized after initiation of goal-directed medical therapy for heart failure and holding osimertinib. The patient was subsequently started on afatinib, a second-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), without recurrence of cardiomyopathy. Conclusions This case highlights the need to better understand osimertinib-induced cardiotoxicity and strategies to optimize oncologic care in patients who develop severe cardiac toxicities from cancer therapy. It further underlines the importance of specialized multidisciplinary care of cancer patients who develop cardiotoxicities to optimize their oncologic outcomes.

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Section: Discussionmentioning

confidence: 99%

Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report

Patel,

Hsu,

Lou

et al. 2023

Cardio-Oncology

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“…A signal cascade that has a strong association with the homeostasis of the myocardium might be suppressed by EGFR TKIs. Furthermore, EGFR TKI might inhibit the proper activity of mitochondria and cause their apoptosis and suppress the HER2 receptor, which may also prevent the proper myocardial differentiation [8].…”

Section: Discussionmentioning

confidence: 99%

A systematic review of epidermal growth factor receptor tyrosine kinase inhibitor-induced heart failure and its management

et al. 2022

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Background Multiple case reports and case series have been published on heart failure due to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs), yet the management and outcome of the said disease have been scarcely discussed in sufficient details. This review is aimed at characterizing the signs, symptoms, laboratory parameters, and outcomes of this entity by analyzing recent published case reports and case series reporting new-onset heart failure in non-small cell lung cancer tumor (NSCLC) patients who are being treated with EGFR TKIs. Methods This is a systematic review of case reports and case series for cases of EGFR TKI-induced heart failure. A systematic search was conducted across a number of databases starting with PubMed databases utilizing its MeSH database; after that, a complementary search through Google Scholar was conducted. Results In total, 23 cases of epidermal growth factor receptor tyrosine kinase inhibitor-induced heart failure were included. The majority of the reported case were females (20 females and three males) with a male-to-female ratio of 1:6.6. Ages ranged from 47 to 91 years of age with a mean age of 70.73 and a median of 71 years of age. Symptom improvement and being symptom-free from a heart failure perspective after treatment from the acute event were observed in 18 cases (78.26%) while heart failure progressively worsened and led to the death of the patient in only one case (4.3%). Conclusion The utilization of EGFR TKIs in NSCLCs has been associated with a better outcome and fewer side effects when compared to classical chemotherapeutic agents. However, cardiotoxic effects, such as heart failure, could be significant for a small proportion of patients. Recent papers have reported heart failure in younger and cardiac risk-free patients. Still, it is only advised to monitor for heart failure in the high-risk group. Treatment should be individualized and based on a case-by-case basis.

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Carvedilol/osimertinib

2022

Reactions Weekly

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Successful Management of Osimertinib-Induced Heart Failure

Cited by 5 publications

References 13 publications

Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report

Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report

A systematic review of epidermal growth factor receptor tyrosine kinase inhibitor-induced heart failure and its management

Carvedilol/osimertinib

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