Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report

Karishma Patel; Kristie Y Hsu; Kevin Lou; Krishan Soni; Yoo Jin Lee; Claire K Mulvey; Alan H Baik

doi:10.1186/s40959-023-00190-1

Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report

Cardiooncology. 2023 Oct 31;9(1):38. doi: 10.1186/s40959-023-00190-1.

Authors

Karishma Patel¹, Kristie Y Hsu¹, Kevin Lou¹, Krishan Soni^{1

2}, Yoo Jin Lee³, Claire K Mulvey^{1

4}, Alan H Baik^{5

6

7}

Affiliations

¹ Department of Medicine, University of California, San Francisco, CA, USA.
² Division of Cardiology, University of California, San Francisco, CA, USA.
³ Department of Radiology, University of California, San Francisco, CA, USA.
⁴ Division of Oncology, University of California, San Francisco, CA, USA.
⁵ Department of Medicine, University of California, San Francisco, CA, USA. alan.baik@ucsf.edu.
⁶ Division of Cardiology, University of California, San Francisco, CA, USA. alan.baik@ucsf.edu.
⁷ Department of Medicine, Division of Cardiology, Section of Cardio-Oncology and Immunology, University of California, San Francisco, CA, USA. alan.baik@ucsf.edu.

Abstract

Background: Osimertinib is a third-generation epidermal growth factor receptor (EGFR) inhibitor that is currently the first-line treatment for metastatic EGFR-mutated non-small-cell lung cancer (NSCLC) due to its favorable efficacy and tolerability profile compared to previous generations of EGFR inhibitors. However, it can cause uncommon, yet serious, cardiovascular adverse effects.

Case presentation: We present the case of a 63-year-old man with EGFR-mutated NSCLC treated with osimertinib who developed new-onset non-ischemic cardiomyopathy with biventricular dysfunction and heart failure in the context of an enlarging pericardial effusion. For the first time, we demonstrate cardiac MR imaging findings associated with osimertinib-associated cardiomyopathy, including focal late gadolinium enhancement and myocardial edema. The patient's biventricular function normalized after initiation of goal-directed medical therapy for heart failure and holding osimertinib. The patient was subsequently started on afatinib, a second-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), without recurrence of cardiomyopathy.

Conclusions: This case highlights the need to better understand osimertinib-induced cardiotoxicity and strategies to optimize oncologic care in patients who develop severe cardiac toxicities from cancer therapy. It further underlines the importance of specialized multidisciplinary care of cancer patients who develop cardiotoxicities to optimize their oncologic outcomes.

Keywords: Cardio-oncology; Cardiomyopathy; Osimertinib; Pericardial effusion; Tamponade.