{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:11:13Z","timestamp":1778735473025,"version":"3.51.4"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Statin-induced myopathy is a common adverse effect and the risk of myopathy is increased by interacting drugs, usually inhibitor of CYP3A4. Almonertinib is a novel third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and is a moderately sensitive substrate of CYP3A4. Here we report a case of myopathy probably caused by concomitant use of atorvastatin and almonertinib.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 89-year-old male patient with coronary heart disease and lung cancer was admitted to the hospital due to worsened chest tightness and shortness of breath for one week. He had been taking almonertinib for 26 months, hybutimibe for 3 months and alirocumab for 1 month prior to admission. Atorvastatin was added because the patient failed to reach the target cholesterol concentration. He presented with myasthenia and markedly elevated his serum creatine kinase (CK) (2,103\u2005U\/L; normal range &amp;lt;164\u2005U\/L) 1 day later. Drug-induced myopathy was diagnosed with a probable drug-drug interaction between atorvastatin and almonertinib. After discontinuation of the two drugs, the patient's CK returned to normal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Almonertinib is a moderately sensitive substrate of CYP3A4, thereby may elevate statin concentration and increase the likelihood of developing myopathy. For patients who need to take almonertinib and cholesterol-lowering drugs simultaneously, proprotein convertase subtilisin\/kexin type 9 (PCSK9) inhibitors and cholesterol absorption inhibitors (such as ezetimibe and hybutimibe) can be considered instead of atorvastatin for the reduction of cardiovascular events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1805200","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:28:25Z","timestamp":1778732905000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Atorvastatin and almonertinib-induced myopathy in a polypharmacy context: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Jifang","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lixia","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Yuecheng District People\u2019s Hospital of Shaoxing","place":["Shaoxing, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huimin","family":"Xu","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1002\/ejhf.1920","article-title":"Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society","volume":"22","author":"Lyon","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"B2","year":""},{"key":"B3","doi-asserted-by":"publisher","first-page":"3168","DOI":"10.1016\/j.jacc.2018.11.002","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"73","author":"Grundy","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e38","DOI":"10.1161\/ATV.0000000000000073","article-title":"Statin safety and associated adverse events: a scientific statement from the American Heart Association","volume":"39","author":"Newman","year":"2019","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1016\/j.jtho.2020.11.028","article-title":"Beyond osimertinib: the development of third-generation EGFR tyrosine kinase inhibitors for advanced EGFR+ NSCLC","volume":"16","author":"Nagasaka","year":"2021","journal-title":"J Thorac Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.jtho.2021.10.024","article-title":"Efficacy of aumolertinib (HS-10296) in patients with advanced EGFR T790M+ NSCLC: updated post-national medical products administration approval results from the APOLLO registrational trial","volume":"17","author":"Lu","year":"2022","journal-title":"J Thorac Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.lungcan.2019.07.007","article-title":"Safety, tolerability, and anti-tumor activity of olmutinib in non-small cell lung cancer with T790M mutation: a single arm, open label, phase 1\/2 trial","volume":"135","author":"Kim","year":"2019","journal-title":"Lung Cancer"},{"key":"B8","doi-asserted-by":"publisher","first-page":"3162","DOI":"10.1200\/JCO.21.02641","article-title":"AENEAS: a randomized phase III trial of aumolertinib versus gefitinib as first-line therapy for locally advanced or metastatic non-small-cell lung cancer with EGFR exon 19 deletion or L858R mutations","volume":"40","author":"Lu","year":"2022","journal-title":"J Clin Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"6203","DOI":"10.3390\/cancers13246203","article-title":"Acute and long-term outcomes of ST-elevation myocardial infarction in cancer patients, a \u201creal world\u201d analysis with 175,000 patients","volume":"13","author":"Lange","year":"2021","journal-title":"Cancers"},{"key":"B10","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1186\/s12911-022-01978-4","article-title":"Detection of statin-induced rhabdomyolysis and muscular related adverse events through data mining technique","volume":"22","author":"Kunakorntham","year":"2022","journal-title":"BMC Med Inform Decis Mak"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1038\/s41401-021-00710-8","article-title":"Itraconazole and rifampicin, as CYP3A modulators but not P-gp modulators, affect the pharmacokinetics of almonertinib and active metabolite HAS-719 in healthy volunteers","volume":"43","author":"Liu","year":"2022","journal-title":"Acta Pharmacol Sin"},{"key":"B12","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.jacl.2022.05.068","article-title":"NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient","volume":"16","author":"Cheeley","year":"2022","journal-title":"J Clin Lipidol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1002\/cpt.2557","article-title":"The clinical pharmacogenetics implementation consortium guideline for SLCO1B1, ABCG2, and CYP2C9 genotypes and statin-associated musculoskeletal symptoms","volume":"111","author":"Cooper-DeHoff","year":"2022","journal-title":"Clin Pharmacol Ther"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e71770","DOI":"10.1371\/journal.pone.0071770","article-title":"Epidermal growth factor receptor down-regulation triggers human myoblast differentiation","volume":"8","author":"Leroy","year":"2013","journal-title":"PLoS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1080\/14740338.2020.1747431","article-title":"An overview of statin-induced myopathy and perspectives for the future","volume":"19","author":"Nikolic","year":"2020","journal-title":"Expert Opin Drug Saf"},{"key":"B16","doi-asserted-by":"publisher","first-page":"11687","DOI":"10.3390\/ijms222111687","article-title":"Statin-associated myopathy: emphasis on mechanisms and targeted therapy","volume":"22","author":"Vinci","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1097\/00131402-200206000-00002","article-title":"Myopathy associated with HMG-CoA reductase inhibitors (statins): a series of 10 patients and review of the literature","volume":"3","author":"McKelvie","year":"2002","journal-title":"J Clin Neuromuscul Dis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1080\/17425255.2020.1801634","article-title":"An updated review of pharmacokinetic drug interactions and pharmacogenetics of statins","volume":"16","author":"Hirota","year":"2020","journal-title":"Expert Opin Drug Metab Toxicol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1080\/14740338.2018.1394455","article-title":"Statin drug interactions and related adverse reactions: an update","volume":"17","author":"Bellosta","year":"2018","journal-title":"Expert Opin Drug Saf"},{"key":"B20","doi-asserted-by":"publisher","first-page":"128","DOI":"10.21037\/tlcr-20-812","article-title":"Cholesterol synthesis disruption combined with a molecule-targeted drug is a promising metabolic therapy for EGFR mutant non-small cell lung cancer","volume":"10","author":"Luo","year":"2021","journal-title":"Transl Lung Cancer Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2444","DOI":"10.3390\/jcm12062444","article-title":"Management of statin intolerant patients in the era of novel lipid lowering therapies: a critical approach in clinical practice","volume":"12","author":"Bosco","year":"2023","journal-title":"J Clin Med"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1805200\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:28:29Z","timestamp":1778732909000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1805200\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":21,"alternative-id":["10.3389\/fcvm.2026.1805200"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1805200","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]},"article-number":"1805200"}}