Why the study?
Entrectinib is approved for ROS1-positive non-small cell lung cancer but carries known yet rare cardiotoxic risks.
Entrectinib may induce early, life-threatening ventricular tachyarrhythmias that can be rescued with therapeutic plasma exchange and mechanical circulatory support.
Entrectinib may trigger early refractory ventricular tachyarrhythmias; this case report leaves open the need for prospective cardiac monitoring studies in ROS1-positive NSCLC.
BACKGROUND: Entrectinib is a targeted therapy that has been approved for the treatment of ROS1-positive non-small cell lung cancer. However, this therapy is associated with known but rare cardiotoxic risks. CASE PRESENTATION: We report a case of ventricular tachyarrhythmias occurring on day 4 after entrectinib initiation in a 37-year-old Han Chinese man with ROS1-positive metastatic lung adenocarcinoma. The arrhythmias was refractory to pharmacologic and electrical therapy, resulting in hemodynamic collapse and the need for venoarterial extracorporeal membrane oxygenation. The diagnostic workup excluded other causes, and therapeutic plasma exchange led to rhythm stabilization and cardiac recovery. The patient was successfully weaned from extracorporeal membrane oxygenation by day 5. CONCLUSIONS: This case highlights a potentially fatal early-phase cardiac complication of entrectinib and supports the use of early electrocardiographic monitoring and therapeutic plasma exchange as management and rescue strategies.
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Tang et al. (2025) studied this question.
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