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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Wednesday, January 8, 2025
Patients diagnosed with EGFR-mutant non–small cell lung cancer (NSCLC) who receive the third-generation EGFR tyrosine kinase inhibitor (TKI) osimertinib appear to have significantly more cancer therapy–related cardiac events than those receiving other, earlier-generation EGFR TKIs, according to a cohort study of more than 400 patients in Taiwan published in JAMA Network Open. According to Chien-Yu Lin, MD, of National Cheng Kung University, Tainan, Taiwan, and colleagues, cancer therapy–related cardiac events were also found to be independently associated with overall survival (P < .001).
Patients who receive osimertinib should have close cardiac monitoring, declared the authors, regardless of the presence or absence of other cardiac risk factors. They noted, too, that the scenario is particularly critical for Asian patients, who tend to have a high prevalence of EGFR variants. The cancer therapy–related cardiac events considered included newly emerging arrhythmia, valvular heart diseases, myocardial infarction, and heart failure.
All cancer therapy–related cardiac events were analyzed after adjusting for age, sex, smoking, alcohol consumption, body mass index, cardiovascular comorbidities, thoracic radiotherapy, and cardiovascular medications. The 401 patients with EGFR-mutant NSCLC (63.1% female; mean age, 69.2 years) began treatment with EGFR TKIs (195 osimertinib; 206 other EGFR TKIs) between 2019 and 2022 (median follow-up, 23.2 months).
Almost 15% of the osimertinib group experienced cancer therapy–related cardiac events, vs 4.4% of those treated with other EGFR TKIs (29 vs 9 patients; P = .002). After the investigators adjusted for relevant cardiovascular risk factors, the adjusted subdistribution hazard ratio of cancer therapy–related cardiac events was significantly higher, at 4.00, in the osimertinib-treated group (P < .001), concluded Dr. Lin and co-investigators.
Disclosure: For full disclosures of the study authors, visit JAMANetwork.com.
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