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Entrectinib-Induced Sinus Bradycardia in a Patient With Metastatic Non-Small Cell Lung Cancer
Azita H Talasaz1, Anne J Goldberg2, Catherine A Shu3
1Department of Pharmacy, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA.
Background:
Targeted therapies like tyrosine kinase inhibitors have significantly improved outcomes in non-small cell lung cancer. Entrectinib, a multikinase inhibitor, showed efficacy in ROS1 fusion-positive NSCLC, including intracranial metastases. Although generally well tolerated, rare but serious cardiac adverse effects have been reported.
Case Summary:
We report a 51-year-old woman with ROS1-mutant metastatic non-small cell lung cancer who developed symptomatic sinus bradycardia during entrectinib therapy. After disease progression on crizotinib, lorlatinib, and reprotrectinib, she was started on entrectinib. Within 1 week, she developed marked bradycardia (38-48 beats/min) with lightheadedness. Electrocardiogram and echocardiography confirmed sinus bradycardia with mildly reduced ejection fraction. Entrectinib was discontinued, and symptoms resolved with heart rate normalization.
Take-Home Messages:
Sinus bradycardia may be a rare but significant side effect of entrectinib, possibly related to ALK inhibition. Cardiac monitoring and multidisciplinary management are essential when initiating therapy with ALK/ROS1 inhibitors.
Insights
Entrectinib, a targeted therapy for non-small cell lung cancer, can cause rare but serious sinus bradycardia. Patients on ALK/ROS1 inhibitors require cardiac monitoring and multidisciplinary care.
Area of Science:
- Oncology
- Pharmacology
- Cardiology
Background:
- Tyrosine kinase inhibitors have improved non-small cell lung cancer (NSCLC) outcomes.
- Entrectinib is effective for ROS1-positive NSCLC, including brain metastases.
- Rare cardiac adverse events are associated with entrectinib.
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