Osimertinib, a third-generation tyrosine kinase inhibitor, is the first-line treatment for metastatic non-small cell lung cancer (NSCLC) with sensitizing epidermal growth factor receptor (EGFR) mutations. It is known to cause drug-induced cardiotoxicity, including QT prolongation syndrome, heart failure, and ventricular arrhythmias, which can lead to sudden death. Once severe arrhythmias occur, it is difficult to continue osimertinib treatment. We report a case of a 66-year-old woman with recurrent NSCLC after concurrent chemoradiotherapy who experienced osimertinib-induced ventricular arrhythmia-causing syncope. The patient was initially treated with concurrent chemoradiotherapy, and genetic testing revealed EGFR exon 19 deletion. Three years following treatment initiation, the primary tumor progressed, and new bone metastases developed. The patient was diagnosed with recurrent NSCLC and was treated with targeted therapy with osimertinib. On the 10th day of osimertinib administration, syncope occurred. Electrocardiography showed polymorphic non-sustained ventricular tachycardia, which was believed to be the cause of syncope. The patient was switched to erlotinib. Two and a half years later, disease progression in the primary lesion was observed. A liquid biopsy revealed an EGFR T790M resistance mutation. Therefore, osimertinib (40 mg) was administered every alternate day. After confirming the absence of palpitations and arrhythmias on electrocardiogram, the osimertinib dosing was increased to 40 mg daily. Thereafter, no further events occurred, and tumor shrinkage was observed. Low-dose osimertinib rechallenge after induced ventricular arrhythmia may be considered an option under close monitoring; however, osimertinib rechallenge must be carefully selected based on the risk-benefit analysis.

中文翻译：

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奥希替尼诱发室性心动过速后成功重新服用奥希替尼：病例报告。

奥希替尼是第三代酪氨酸激酶抑制剂，是治疗具有敏感表皮生长因子受体（EGFR）突变的转移性非小细胞肺癌（NSCLC）的一线治疗药物。已知它会引起药物引起的心脏毒性，包括 QT 间期延长综合征、心力衰竭和室性心律失常，从而导致猝死。一旦出现严重心律失常，就很难继续奥希替尼治疗。我们报告了一名 66 岁女性患者，她在同步放化疗后复发非小细胞肺癌，并经历了奥希替尼诱发的室性心律失常导致晕厥。该患者最初接受同步放化疗，基因检测显示 EGFR 外显子 19 缺失。治疗开始三年后，原发肿瘤进展，并出现新的骨转移。该患者被诊断为复发性非小细胞肺癌，并接受奥希替尼靶向治疗。奥希替尼给药第10天，出现晕厥。心电图显示多形性非持续性室性心动过速，这被认为是晕厥的原因。患者改用厄洛替尼。两年半后，观察到原发病灶的疾病进展。液体活检显示 EGFR T790M 耐药突变。因此，每隔一天给予奥希替尼（40 mg）。确认心电图无心悸和心律失常后，奥希替尼剂量增加至每日 40 mg。此后，没有发生进一步的事件，并且观察到肿瘤缩小。诱发室性心律失常后，在密切监测下可考虑重新服用小剂量奥希替尼；然而，必须根据风险效益分析仔细选择奥希替尼再挑战。