The QT interval prolongation potential of anticancer and supportive drugs: a comprehensive overview.

Eline L Giraud, Kaylee R M Ferrier, Nienke A G Lankheet, Ingrid M E Desar, Neeltje Steeghs, Rypko J Beukema, Nielka P van Erp, Elise J Smolders

Journal: The Lancet. Oncology 2022;23(9):e406-e415

PMID: 36055309

Full Text on Elsevier Science View on PubMed

Abstract

Patients with cancer are prone to prolongation of the corrected QT interval (QTc) due to the use of anticancer drugs with QTc-prolonging potential in combination with electrolyte imbalances caused by, for example, gastrointestinal side-effects. However, most anticancer drugs were approved with little information on their QTc-prolonging potential and the added risk of torsade de pointes. The absence of this information on the drug label poses a considerable challenge to clinicians regarding the measures that need to be taken to safely start anticancer treatment. In this Review, we provide a comprehensive overview of the evidence for the QTc-prolonging properties of 205 anticancer drugs and 14 antiemetic drugs available from drug labels, assessment reports, and published studies. We classify the drugs as low-risk, moderate-risk, or high-risk for QTc prolongation. We also discuss the clinical relevance of these findings and include practical recommendations to guide clinicians to select the drugs with the least QTc-prolonging properties and to adequately monitor susceptible patients.

Address: Department of Clinical Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.; Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, Netherlands.; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands.; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.; Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands.; Department of Clinical Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands; Department of Clinical Pharmacy, Isala Hospital, Zwolle, Netherlands. Electronic address: [email protected].

DOI: 10.1016/S1470-2045(22)00221-2

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MeSH Terms: Humans, Long QT Syndrome, Risk Factors, Torsades de Pointes