A systematic review of epidermal growth factor receptor tyrosine kinase inhibitor-induced heart failure and its management

Abstract

Background Multiple case reports and case series have been published on heart failure due to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs), yet the management and outcome of the said disease have been scarcely discussed in sufficient details. This review is aimed at characterizing the signs, symptoms, laboratory parameters, and outcomes of this entity by analyzing recent published case reports and case series reporting new-onset heart failure in non-small cell lung cancer tumor (NSCLC) patients who are being treated with EGFR TKIs. Methods This is a systematic review of case reports and case series for cases of EGFR TKI-induced heart failure. A systematic search was conducted across a number of databases starting with PubMed databases utilizing its MeSH database; after that, a complementary search through Google Scholar was conducted. Results In total, 23 cases of epidermal growth factor receptor tyrosine kinase inhibitor-induced heart failure were included. The majority of the reported case were females (20 females and three males) with a male-to-female ratio of 1:6.6. Ages ranged from 47 to 91 years of age with a mean age of 70.73 and a median of 71 years of age. Symptom improvement and being symptom-free from a heart failure perspective after treatment from the acute event were observed in 18 cases (78.26%) while heart failure progressively worsened and led to the death of the patient in only one case (4.3%). Conclusion The utilization of EGFR TKIs in NSCLCs has been associated with a better outcome and fewer side effects when compared to classical chemotherapeutic agents. However, cardiotoxic effects, such as heart failure, could be significant for a small proportion of patients. Recent papers have reported heart failure in younger and cardiac risk-free patients. Still, it is only advised to monitor for heart failure in the high-risk group. Treatment should be individualized and based on a case-by-case basis.

Onset of takotsubo syndrome induced by osimertinib in a patient with lung adenocarcinoma

“…In a systematic review of case reports and a series describing EGFR-TKI-induced heart failure in NSCLC, osimertinib was administered in 82.6 % of the cases [ 10 ], implying that heart failure due to osimertinib is more likely to develop than heart failure due to other EGFR-TKIs (afatinib, erlotinib, and gefitinib). Moreover, the frequency of osimertinib-induced cardiotoxicity is higher than that of other EGFR-TKIs.…”