Can osimertinib (Tagrisso) cause pericardial effusion?

Osimertinib and Pericardial Effusion

Yes, osimertinib (Tagrisso) can cause pericardial effusion, though it is not among the most commonly reported adverse effects of this medication. While specific data on the incidence of osimertinib-induced pericardial effusion is limited, evidence from clinical guidelines and case reports confirms this association.

Evidence for Osimertinib-Induced Pericardial Effusion

• Osimertinib has been documented to cause cardiac complications including pericardial effusion, as demonstrated in case reports showing pericardial effusion development in patients receiving this third-generation EGFR inhibitor 1
• Chest CT imaging has specifically identified pericardial effusion in patients treated with osimertinib, as documented in the Fleischner Society position paper 2
• Osimertinib-induced cardiac toxicity can manifest as various cardiac complications, with pericardial effusion being one potential manifestation 3

Mechanism and Risk Factors

• The exact mechanism of osimertinib-induced pericardial effusion is not fully elucidated, but it likely relates to the drug's effects on cardiac tissue and potential inflammatory responses 3
• Patients with pre-existing cardiovascular conditions, including heart failure, hypertension, and dyslipidemia, may be at higher risk for developing cardiac complications, including pericardial effusion, when treated with osimertinib 3
• Elderly patients are particularly vulnerable to cardiotoxicity from cancer therapies including EGFR inhibitors due to higher prevalence of cardiovascular risk factors and comorbidities 2

Clinical Presentation and Diagnosis

• Patients with osimertinib-induced pericardial effusion may be asymptomatic with small to moderate effusions, or can present with symptoms such as dyspnea, cough, tachycardia, and hypotension if cardiac tamponade develops 2
• Transthoracic echocardiography is the diagnostic method of choice for evaluating pericardial effusion in patients receiving chemotherapy, including osimertinib 2
• CT imaging can also help identify pericardial effusion and may show characteristic findings as demonstrated in published case images of osimertinib-related complications 2

Management Recommendations

• For patients who develop pericardial effusion while on osimertinib, treatment decisions should be based on the severity of the effusion and associated symptoms 2
• Small, asymptomatic effusions may be monitored closely without immediate intervention 2
• For symptomatic effusions or those causing hemodynamic compromise, pericardiocentesis may be required, potentially followed by surgical pericardial windowing 2
• Treatment of pericardial effusion may include non-steroidal anti-inflammatory drugs and colchicine 2
• In cases of severe cardiac toxicity, temporary or permanent discontinuation of osimertinib may be necessary, with consideration of alternative treatment options 1, 3

Monitoring Recommendations

• Patients receiving osimertinib, especially those with pre-existing cardiovascular risk factors, should undergo baseline cardiac evaluation and regular monitoring during treatment 3
• Cardiac toxicity can occur at various timepoints during osimertinib therapy, with approximately 70% of cases occurring within the first 6 months of treatment 3
• Early recognition and intervention are crucial for managing osimertinib-induced cardiac complications, including pericardial effusion 3

Important Considerations

• The presence of malignant effusions (pleural or pericardial) may negatively impact the efficacy of osimertinib treatment in NSCLC patients 4
• Some patients with osimertinib-induced cardiac toxicity may experience improvement and recovery after drug discontinuation and appropriate cardiac management 1, 3
• Alternative EGFR-TKIs may be considered in patients who develop significant cardiac toxicity from osimertinib 1