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Successful Rechallenge with Osimertinib following Osimertinib-Induced Ventricular Tachycardia: A Case Report
Osimertinib, a third-generation tyrosine kinase inhibitor, is the first-line treatment for metastatic non-small cell lung cancer (NSCLC) with sensitizing epidermal growth factor receptor (EGFR) mutations. It is known to cause drug-induced cardiotoxicity, including QT prolongation syndrome, heart fai...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
S. Karger AG
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601787/ https://www.ncbi.nlm.nih.gov/pubmed/37900846 http://dx.doi.org/10.1159/000533826 |
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author | Saito, Zentaro Imakita, Takuma Ito, Takanori Oi, Issei Kanai, Osamu Fujita, Kohei Tachibana, Hiromasa Mio, Tadashi |
author_facet | Saito, Zentaro Imakita, Takuma Ito, Takanori Oi, Issei Kanai, Osamu Fujita, Kohei Tachibana, Hiromasa Mio, Tadashi |
author_sort | Saito, Zentaro |
collection | PubMed |
description | Osimertinib, a third-generation tyrosine kinase inhibitor, is the first-line treatment for metastatic non-small cell lung cancer (NSCLC) with sensitizing epidermal growth factor receptor (EGFR) mutations. It is known to cause drug-induced cardiotoxicity, including QT prolongation syndrome, heart failure, and ventricular arrhythmias, which can lead to sudden death. Once severe arrhythmias occur, it is difficult to continue osimertinib treatment. We report a case of a 66-year-old woman with recurrent NSCLC after concurrent chemoradiotherapy who experienced osimertinib-induced ventricular arrhythmia-causing syncope. The patient was initially treated with concurrent chemoradiotherapy, and genetic testing revealed EGFR exon 19 deletion. Three years following treatment initiation, the primary tumor progressed, and new bone metastases developed. The patient was diagnosed with recurrent NSCLC and was treated with targeted therapy with osimertinib. On the 10th day of osimertinib administration, syncope occurred. Electrocardiography showed polymorphic non-sustained ventricular tachycardia, which was believed to be the cause of syncope. The patient was switched to erlotinib. Two and a half years later, disease progression in the primary lesion was observed. A liquid biopsy revealed an EGFR T790M resistance mutation. Therefore, osimertinib (40 mg) was administered every alternate day. After confirming the absence of palpitations and arrhythmias on electrocardiogram, the osimertinib dosing was increased to 40 mg daily. Thereafter, no further events occurred, and tumor shrinkage was observed. Low-dose osimertinib rechallenge after induced ventricular arrhythmia may be considered an option under close monitoring; however, osimertinib rechallenge must be carefully selected based on the risk-benefit analysis. |
format | Online Article Text |
id | pubmed-10601787 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | S. Karger AG |
record_format | MEDLINE/PubMed |
spelling | pubmed-106017872023-10-27 Successful Rechallenge with Osimertinib following Osimertinib-Induced Ventricular Tachycardia: A Case Report Saito, Zentaro Imakita, Takuma Ito, Takanori Oi, Issei Kanai, Osamu Fujita, Kohei Tachibana, Hiromasa Mio, Tadashi Case Rep Oncol Case Report Osimertinib, a third-generation tyrosine kinase inhibitor, is the first-line treatment for metastatic non-small cell lung cancer (NSCLC) with sensitizing epidermal growth factor receptor (EGFR) mutations. It is known to cause drug-induced cardiotoxicity, including QT prolongation syndrome, heart failure, and ventricular arrhythmias, which can lead to sudden death. Once severe arrhythmias occur, it is difficult to continue osimertinib treatment. We report a case of a 66-year-old woman with recurrent NSCLC after concurrent chemoradiotherapy who experienced osimertinib-induced ventricular arrhythmia-causing syncope. The patient was initially treated with concurrent chemoradiotherapy, and genetic testing revealed EGFR exon 19 deletion. Three years following treatment initiation, the primary tumor progressed, and new bone metastases developed. The patient was diagnosed with recurrent NSCLC and was treated with targeted therapy with osimertinib. On the 10th day of osimertinib administration, syncope occurred. Electrocardiography showed polymorphic non-sustained ventricular tachycardia, which was believed to be the cause of syncope. The patient was switched to erlotinib. Two and a half years later, disease progression in the primary lesion was observed. A liquid biopsy revealed an EGFR T790M resistance mutation. Therefore, osimertinib (40 mg) was administered every alternate day. After confirming the absence of palpitations and arrhythmias on electrocardiogram, the osimertinib dosing was increased to 40 mg daily. Thereafter, no further events occurred, and tumor shrinkage was observed. Low-dose osimertinib rechallenge after induced ventricular arrhythmia may be considered an option under close monitoring; however, osimertinib rechallenge must be carefully selected based on the risk-benefit analysis. S. Karger AG 2023-10-11 /pmc/articles/PMC10601787/ /pubmed/37900846 http://dx.doi.org/10.1159/000533826 Text en © 2023 The Author(s). Published by S. Karger AG, Basel https://creativecommons.org/licenses/by-nc/4.0/This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission. |
spellingShingle | Case Report Saito, Zentaro Imakita, Takuma Ito, Takanori Oi, Issei Kanai, Osamu Fujita, Kohei Tachibana, Hiromasa Mio, Tadashi Successful Rechallenge with Osimertinib following Osimertinib-Induced Ventricular Tachycardia: A Case Report |
title | Successful Rechallenge with Osimertinib following Osimertinib-Induced Ventricular Tachycardia: A Case Report |
title_full | Successful Rechallenge with Osimertinib following Osimertinib-Induced Ventricular Tachycardia: A Case Report |
title_fullStr | Successful Rechallenge with Osimertinib following Osimertinib-Induced Ventricular Tachycardia: A Case Report |
title_full_unstemmed | Successful Rechallenge with Osimertinib following Osimertinib-Induced Ventricular Tachycardia: A Case Report |
title_short | Successful Rechallenge with Osimertinib following Osimertinib-Induced Ventricular Tachycardia: A Case Report |
title_sort | successful rechallenge with osimertinib following osimertinib-induced ventricular tachycardia: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601787/ https://www.ncbi.nlm.nih.gov/pubmed/37900846 http://dx.doi.org/10.1159/000533826 |
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