Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China.
Front Endocrinol (Lausanne). 2022 May 23;13:833929. doi: 10.3389/fendo.2022.833929. eCollection 2022.
Osimertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) first-line therapy, has shown good clinical outcomes in non-small cell lung cancer (NSCLC), but some serious adverse events such as cardiotoxicity have also been reported. Here, we present the first NSCLC case with osimertinib-induced cardiac failure. The case is successfully being treated by switching to another third-generation TKI, aumolertinib. A 62-year-old non-smoking woman was initially diagnosed with stage cT2aN2M1c IVB NSCLC with synchronous brain and bone metastasis in April 2020. Further genetic screening of the patient identified Leu858Arg (L858R) mutation in EGFR; thus, the patient was administered third-generation TKI osimertinib (80 mg/day) for 6 months. This treatment with osimertinib led to serious cardiac failure but no significant reduction in NSCLC tumor size. To cope with these conditions, another third-generation TKI, aumolertinib (110 mg/day), along with a supplement treatment plan was prescribed to the patient. Interestingly, this new treatment plan of aumolertinib significantly inhibited tumor growth in 8 months. Therefore, we conclude that the administration of second-line aumolertinib 110 mg/day has fewer adverse reactions and high efficacy against NSCLC as compared to osimertinib therapy.
奥希替尼，一种第三代表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）的一线治疗药物，在非小细胞肺癌（NSCLC）中显示出良好的临床疗效，但也有报道称其存在严重的不良反应，如心脏毒性。在这里，我们报告了首例奥希替尼引起的心衰的 NSCLC 病例。该病例通过改用另一种第三代 TKI，阿美替尼，成功得到治疗。一名 62 岁的不吸烟女性于 2020 年 4 月被最初诊断为 cT2aN2M1c IVB 期 NSCLC，同时伴有脑和骨转移。进一步对患者的基因进行筛选发现存在 EGFR 的 Leu858Arg（L858R）突变；因此，患者接受第三代 TKI 奥希替尼（80 mg/天）治疗 6 个月。奥希替尼治疗导致严重的心衰，但 NSCLC 肿瘤大小无明显缩小。为了应对这些情况，为患者开具了另一种第三代 TKI 阿美替尼（110 mg/天）和补充治疗方案。有趣的是，阿美替尼新的治疗方案在 8 个月内显著抑制了肿瘤生长。因此，我们得出结论，与奥希替尼治疗相比，二线阿美替尼 110 mg/天的给药具有更少的不良反应和更高的 NSCLC 疗效。
