Baseline cardiovascular vulnerability stratifies heart failure hospitalization risk during osimertinib therapy, and a seven-predictor nomogram (not externally validated) may serve as a screening aid to identify patients who may benefit from intensified cardiovascular monitoring.
Heart failure hospitalization (HFH) was uncommon but occurred in a measurable minority of patients newly initiating osimertinib.
LASSO logistic regression retained seven baseline predictors for HFH risk during osimertinib therapy.
The model showed moderate discrimination, with little loss after correcting for optimism.
Observed HFH incidence rose steeply across deciles of predicted risk.
Competing-risk and cause-specific analyses gave results consistent with the logistic model.
The resulting nomogram is intended as a screening aid, not a validated clinical tool, because it lacks external validation.
Osimertinib is a standard drug for a type of lung cancer driven by EGFR gene mutations. It can be linked to heart problems, including heart failure that requires hospital admission. This study used a large Japanese insurance claims database to look at 5802 people who had just started osimertinib. About 3 in 100 (169 patients, 2.9%) were hospitalized for heart failure over a median of about 9 months on treatment. More patients died during that time (268) than were hospitalized for heart failure. The researchers used a statistical method to pick out seven pre-treatment factors that best predicted who would be hospitalized, and they combined these into a risk chart (a nomogram). The tool distinguished higher-risk from lower-risk patients reasonably well (a concordance index of about 0.72 after correcting for over-optimism). Patients in the highest predicted-risk group had roughly 10 times the observed rate of heart failure hospitalization (10.5%) compared with those in the lowest group (1.03%). Alternative analyses that accounted for death as a competing event gave closely similar results. This research suggests that patients' existing cardiovascular vulnerability before starting osimertinib helps identify who is at higher risk of heart failure hospitalization. The tool has not been tested in an independent group of patients, so it is not yet proven to work elsewhere. The authors suggest it is best used as a screening aid to flag patients who might benefit from closer heart monitoring, not as a stand-alone decision tool.
Sugimoto T, Noguchi Y, Masuda R, Tani S, Harada T, Toyama Y, et al.. (2026). Risk Stratification and Factors Associated with Heart Failure Hospitalization During Osimertinib Therapy.. Current oncology (Toronto, Ont.). https://doi.org/10.3390/curroncol33100586