Okuzumi Shinichi, Matsuda Masahiro, Nagao Genta, Kakimoto Tomoo, Minematsu Naoto
Department of Medicine, Hino Municipal Hospital, Hino-shi, JPN.
Cureus. 2022 Aug 5;14(8):e27694. doi: 10.7759/cureus.27694. eCollection 2022 Aug.
Osimertinib is widely used for the treatment of advanced lung cancers harboring () mutations. Because of its inhibitory activity on the human epidermal growth factor receptor 2 pathway, osimertinib-induced cardiotoxicity is concerning. Large-scale international clinical studies revealed a subclinical decline in the left ventricular ejection fraction (LVEF) with osimertinib, which allowed a continuation of the drug. Only a few studies have reported symptomatic heart failure with reduced ejection fraction (HFrEF) with osimertinib, and its clinical impact in real-world settings remains unclear. A 91-year-old man was diagnosed with lung adenocarcinoma harboring an mutation and was started on osimertinib. The treatment conferred substantial tumor regression; however, the patient presented with symptomatic HFrEF six weeks after osimertinib initiation. Transthoracic echocardiography demonstrated diffuse hypokinesis of the left ventricular walls with a significantly reduced ejection fraction from the baseline. Initial evaluation showed no causative cause of heart failure, and we suspected osimertinib-associated cardiomyopathy. Discontinuation of the drug along with the cardioprotective approach improved cardiac symptoms and restored the LVEF to baseline within a week. Here, we comprehensively review the literature and discuss the clinical features of HFrEF following osimertinib administration. Physicians should be aware of rare complications associated with osimertinib therapy.
奥希替尼被广泛用于治疗携带（）突变的晚期肺癌。由于其对人类表皮生长因子受体2通路的抑制活性，奥希替尼引起的心脏毒性令人担忧。大规模国际临床研究显示，使用奥希替尼会导致左心室射血分数（LVEF）出现亚临床下降，但仍可继续使用该药物。仅有少数研究报告了奥希替尼导致的有症状的射血分数降低的心力衰竭（HFrEF），其在现实环境中的临床影响仍不明确。一名91岁男性被诊断为携带一种突变的肺腺癌，并开始使用奥希替尼治疗。治疗使肿瘤显著消退；然而，患者在开始使用奥希替尼六周后出现了有症状的HFrEF。经胸超声心动图显示左心室壁弥漫性运动减弱，射血分数较基线显著降低。初步评估未发现心力衰竭的病因，我们怀疑是奥希替尼相关的心肌病。停药并采取心脏保护措施后，心脏症状得到改善，LVEF在一周内恢复到基线水平。在此，我们全面回顾了相关文献，并讨论了使用奥希替尼后HFrEF的临床特征。医生应意识到奥希替尼治疗相关的罕见并发症。
