Osimertinib-Induced Cardiotoxicity: A Retrospective Review of the FDA Adverse Events Reporting System (FAERS)
Kartik Anand1, Joe Ensor2, Barry Trachtenberg3
1Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, Texas, USA.
Objectives:
The goal of this study was to compare the risk of cardiotoxicity with osimertinib versus all other drugs and versus epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) (erlotinib, afatinib, and gefitinib) in the U.S. Food and Drug Administration Adverse Events Reporting System (FAERS), a pharmacovigilance database.
Background:
Osimertinib has been shown to improve outcomes in T790M-positive non-small cell lung cancer patients who progress on EGFR-TKI therapy and in the frontline setting in EGFR mutated non-small cell lung cancer. In pivotal trials, osimertinib was associated with higher rates of cardiotoxicity compared with the control arm.
Methods:
FAERS was queried for "Cardiac failure," "Electrocardiogram QT-prolonged," "Atrial Fibrillation (AF)," "Myocardial Infarction (MI)," and "Pericardial Effusion" secondary to "Osimertinib," "Erlotinib," "Afatinib," "Gefitinib," and all other drugs from 2016 to 2018. Disproportionality signal analysis was performed by calculating the reporting odds ratio (ROR) with its 95% confidence interval (CI). The ROR was considered significant when the lower limit of the 95% CI was >1.0.
Results:
The ROR (95% CI) for cardiac failure, atrial fibrillation (AF), QT prolongation, myocardial infarction, and pericardial effusion due to osimertinib versus all other drugs in FAERS was 5.4 (4.2 to 7.1), 4.0 (2.8 to 5.8), 11.2 (7.9 to 15.8), 1.6 (0.9 to 2.6), and 8.2 (4.8 to 14), respectively. The ROR (95% CI) for cardiac failure, AF, QT prolongation, myocardial infarction, and pericardial effusion in comparing osimertinib versus other EGFR-TKIs was 2.2 (1.5 to 3.2), 2.1 (1.3 to 3.5), 6.6 (3.4 to 12.8), 1.2 (0.6 to 2.3), and 1.6 (0.8 to 3.3).
Conclusions:
The RORs for cardiac failure, AF, and QT prolongation were higher due to osimertinib compared with other TKIs. Electrocardiographic monitoring for QT prolongation and monitoring for signs and symptoms of heart failure should be considered in patients taking osimertinib.
Insights
Osimertinib use is associated with increased cardiotoxicity risks, including heart failure and QT prolongation, compared to other drugs and EGFR-TKIs. Monitoring for these adverse events is recommended for patients taking osimertinib.
Area of Science:
- Pharmacovigilance
- Oncology
- Cardiology
Background:
- Osimertinib improves outcomes in non-small cell lung cancer (NSCLC) but shows higher cardiotoxicity in trials.
- This study investigates cardiotoxicity risks of osimertinib in a real-world setting.
Purpose of the Study:
- To compare cardiotoxicity risk of osimertinib against all other drugs.
- To compare cardiotoxicity risk of osimertinib against other EGFR-TKIs (erlotinib, afatinib, gefitinib).
Main Methods:
- Utilized the FDA Adverse Events Reporting System (FAERS) from 2016-2018.
- Analyzed reporting odds ratios (ROR) for cardiac failure, QT prolongation, atrial fibrillation, myocardial infarction, and pericardial effusion.
- Defined significant ROR as lower limit of 95% CI >1.0.
Main Results:
- Osimertinib showed significantly higher RORs for cardiac failure (5.4), AF (4.0), QT prolongation (11.2), and pericardial effusion (8.2) versus all other drugs.
- Osimertinib also had higher RORs for cardiac failure (2.2), AF (2.1), and QT prolongation (6.6) versus other EGFR-TKIs.
Conclusions:
- Osimertinib is linked to increased risks of cardiac failure, AF, and QT prolongation compared to other TKIs.
- Recommend ECG monitoring for QT prolongation and heart failure surveillance in osimertinib-treated patients.
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