Belamkar Aditya V, Mounayar Marwan, Clasen Suparna C
Indiana University School of Medicine, Indianapolis, Indiana, USA.
Indiana University Health Ball Memorial Hospital Cancer Center, Muncie, Indiana, USA.
JACC Case Rep. 2024 Dec 4;29(23):102829. doi: 10.1016/j.jaccas.2024.102829.
An 85-year-old man with recently diagnosed metastatic EGFR+ lung adenocarcinoma treated with osimertinib presented after 1 month of therapy in decompensated congestive heart failure along with atrial fibrillation, prolonged QTc and acute kidney injury. Osimertinib was held. His hemodynamic status was optimized, and he was started on cardioprotective medications (losartan and metoprolol succinate), and LVEF recovered. However, after reintroducing osimertinib, LVEF reduced, indicating possible osimertinib-induced cardiomyopathy. An SGLT2 inhibitor was added for cardioprotection before another rechallenge of osimertinib. SGLT2 inhibitors are a powerful tool for heart failure and may have a potential secondary benefit in ameliorating cardiotoxic processes. Although their use in osimertinib-induced cardiomyopathy has not been well-established, current heart failure guidelines and emerging research support its use in this setting. This case and the accompanying literature review highlight the novel use of SGLT2 inhibitors coupled with regular clinical and imaging monitoring, as a compelling intervention for osimertinib-induced cardiomyopathy.
一名85岁男性，近期诊断为转移性表皮生长因子受体（EGFR）阳性肺腺癌，接受奥希替尼治疗。治疗1个月后，出现失代偿性充血性心力衰竭，伴有心房颤动、QTc延长和急性肾损伤，遂停用奥希替尼。优化其血流动力学状态后，开始使用心脏保护药物（氯沙坦和琥珀酸美托洛尔），左心室射血分数（LVEF）恢复。然而，重新使用奥希替尼后，LVEF降低，提示可能为奥希替尼所致的心肌病。在再次尝试使用奥希替尼之前，加用了一种钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂以保护心脏。SGLT2抑制剂是治疗心力衰竭的有力工具，可能对改善心脏毒性过程具有潜在的次要益处。尽管其在奥希替尼所致心肌病中的应用尚未得到充分证实，但目前的心力衰竭指南和新出现的研究支持在这种情况下使用。该病例及相关文献综述强调了SGLT2抑制剂与定期临床和影像学监测相结合的新用途，作为对奥希替尼所致心肌病的一种有说服力的干预措施。
