Gefitinib-Induced Heart Failure Confirmed by a Rechallenge in a Patient with EGFR-Mutated Lung Adenocarcinoma

Area of Science:

• Oncology
• Cardiology
• Pharmacology

Background:

• Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are standard treatments for EGFR-mutated lung adenocarcinoma.
• Cardiotoxicity is a known, though less common, side effect of some EGFR TKIs.
• Sequential use of different EGFR TKIs may present unique challenges regarding cumulative toxicity.

Purpose of the Study:

• To report a rare case of sequential cardiotoxicity from two different EGFR TKIs in a patient with lung adenocarcinoma.
• To emphasize the potential for cumulative cardiac adverse events when switching between EGFR TKIs.
• To underscore the importance of vigilant cardiac monitoring during EGFR TKI therapy.

Main Methods:

• Case report of an 84-year-old woman with EGFR-mutated lung adenocarcinoma.
• Detailed clinical course including sequential treatment with osimertinib and gefitinib.
• Cardiac monitoring including electrocardiogram (ECG) and echocardiogram.

Main Results:

• Osimertinib induced QT prolongation without systolic dysfunction.
• Gefitinib induced heart failure with reduced ejection fraction, which resolved upon withdrawal and recurred upon rechallenge.
• This represents a rare instance of severe gefitinib-induced heart failure following osimertinib-induced electrical instability.

Conclusions:

• Switching between EGFR TKIs, even to first-generation agents, can lead to cumulative cardiotoxicity.
• Careful cardiac monitoring is crucial when managing patients on sequential EGFR TKI therapy.
• Awareness of potential sequential cardiotoxicity is essential for oncologists and cardiologists.