Real-world data from two UK tertiary cancer centers reveal limited cardiac imaging surveillance in patients receiving osimertinib, a third-generation tyrosine kinase inhibitor for epidermal growth factor receptor-mutated metastatic non-small cell lung cancer. The study was presented at the European Society of Cardiology Congress 2025.

A retrospective analysis included 170 adults treated between August 2017 and May 2022, before the 2022 ESC Cardio-Oncology Guidelines recommending baseline and three-monthly transthoracic echocardiograms for all patients on osimertinib. Cardiovascular toxicities—termed cancer therapy-related cardiovascular toxicity—included venous thromboembolism, cancer therapy-related cardiac dysfunction, QTc interval prolongation, and atrial fibrillation.

Incidence rates were 12.9 percent for venous thromboembolism, 5.3 percent for QTc interval prolongation, 1.2 percent for atrial fibrillation, and 1.2 percent for cancer therapy-related cardiac dysfunction. Only 19.4 percent of patients had a baseline echocardiogram, and just 2.9 percent underwent surveillance every three months. All cases of cancer therapy-related cardiac dysfunction were symptomatic.

Compared with prior United States Food and Drug Administration reports, atrial fibrillation and cancer therapy-related cardiac dysfunction were lower, whereas venous thromboembolism and QTc prolongation were higher. Reliance on symptom-driven cardiac assessment may delay detection of subclinical dysfunction and hinder early cardioprotective interventions. A follow-up analysis is underway to assess changes in echocardiographic monitoring after guideline implementation.