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.