Osimertinib

Abstract

Congestive heart failure, QTc prolongation and torsade de pointes: case report An 84-year-old woman developed congestive heart failure, QTc prolongation and torsade de pointes following treatment with osimertinib for recurrent lung adenocarcinoma. The woman, who had stable hypertension, was diagnosed with recurrence of lung adenocarcinoma. She had been previously treated with right upper lobectomy, lymphadenectomy and stereotactic thoracic radiotherapy. She started receiving osimertinib 80 mg/day [route not stated]. At baseline, she did not have any underlying cardiac diseases or remarkable cardiac events. Two months after initiation of the osimertinib, she developed dyspnoea and bilateral lower limb oedema. She presented to the emergency room and was noted to have high blood pressure, tachypnoea, tachycardia and decreased oxygen saturation. Chest x-ray and CT showed cardiomegaly, bilateral pleural effusion and tumour shrinkage. She was hospitalised. Upon admission, ECG revealed QTc prolongation of 524ms and poor R progression. Transthoracic UCG revealed a dilated and diffusely hypocontractile left ventricle. Creatine kinase MB isozyme and troponin T levels were normal whereas NT-proBNP level was elevated. A coronary CT angiography scan was normal. She was diagnosed with congestive heart failure, QTc prolongation and torsade de pointes secondary to osimertinib therapy. The woman’s osimertinib therapy was discontinued. At admission, she experienced repeated torsade de pointes with loss of consciousness. Her arrhythmia was successfully controlled by electrocardioversion. Thereafter, no arrhythmic event was noted. She was treated with furosemide which was later switched to azosemide and spironolactone. She was also treated with enalapril and bisoprolol. Her symptoms gradually improved. She was discharged on 24th hospital day. At discharge, her ECG had returned to normal. At follow-up, her LVEF had improved and NT-proBNP level had decreased. She did not receive any other chemotherapy. Fifteen months after osimertinib discontinuation, she died due to cancer progression and cachexia.