Discussion
Osimertinib is a third-generation oral EGFR tyrosine kinase inhibitor (TKI) used for the treatment of advanced EGFR-mutant NSCLC with acquired T790M mutations. It has also been shown to improve progression-free survival compared to platinum therapy (7). Although cardiotoxicity from EGFR-TKI (human EGFR1: HER1) has been reported to be less than that of HER2, BCR-ABL, and VEGFR inhibitors (3), osimertinib is likely to cause cardiac side effects (4-6).
TC is a transient systolic left ventricular dysfunction with a variety of wall motion abnormalities (8). Elderly women and emotional or physical triggers were considered to be the cause of TC, but conditions without an evident trigger have also been reported (8,9). In a previous study, EGFR was found to be expressed in the central nervous system, and infusion of EGFR into the midbrain had increased dopamine precursor levels in an experimental rat model. One of the mechanisms of osimertinib-induced TC might be that osimertinib, may cross the blood-brain barrier, increasing the dopamine release in the central nervous system (10).
Osimertinib may cause TC, which has the possibility of cause of heart failure. The findings of our case study suggest that osimertinib therapy should not be resumed in patients diagnosed with symptomatic heart failure due to TC induced by osimertinib.