Case History
A 73-year-old woman with no history of smoking underwent a thoracoscopic right upper-middle lobectomy in 2016 for non-small cell lung cancer (NSCLC). Her clinical stage was T2N0M0, and she did not receive adjuvant chemotherapy. One year later, a chest computed tomography (CT) scan showed pleural dissemination, and brain metastasis was suspected based on brain magnetic resonance imaging (MRI). She was admitted to our institution for targeted therapy. One year and 10 months after administering erlotinib and bevacizumab as first-line therapy (a total of 26 courses), pleural dissemination was found to be a progressive disease. Pleural biopsy revealed a T790M mutation.
Osimertinib (80 mg/day, taken orally) was chosen as the second-line therapy. Within one month of starting osimertinib, she was admitted to our institution with progressive shortness of breath, fatigue, and edema in the body and extremities. Chest radiography revealed pulmonary congestion, pleural effusion, and cardiac dilation. An echocardiogram revealed left ventricular akinesis from the apical to the midventricular portion, which did not match with coronary arterial perfusion (Fig 1(A, B)). The left ventricular dimension increased from 34 mm pre-osimertinib treatment to 46 mm, and left ventricular ejection fraction (LVEF) was reduced from 75% to 58%. The eletrcocardiogram changed from normal to a right bundle branch block (Fig 2(A, B). She was diagnosed as symptomatic acute heart failure.