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Management of QT prolongation induced by anti-cancer drugs: Target therapy and old agents. Different algorithms for different drugs.

Abstract The side effects of anticancer drugs still play a critical role in survival and quality of life. Although the recent progresses of cancer therapies have significantly improved the prognosis of oncologic patients, side effects of antineoplastic treatments are still responsible for the increased mortality of cancer survivors. Cardiovascular toxicity is the most dangerous adverse effect induced by anticancer therapies. A survey conducted by the National Health and Nutrition Examination, showed that 1807 cancer survivors followed up for seven years: 51% died of cancer and 33% of heart disease (Vejpongsa and Yeh, 2014). Moreover, the risk of cardiotoxicity persists even with the targeted therapy, the newer type of cancer treatment, due to the presence of on-target and off-target effects related to this new class of drugs. The potential cardiovascular toxicity of anticancer agents includes: QT prolongation, arrhythmias, myocardial ischemia, stroke, hypertension (HTN), thromboembolism, left ventricular dysfunction and heart failure (HF). Compared to other cardiovascular disorders, the interest in QT prolongation and its complications is fairly recent. However, oncologists have to deal with it and to evaluate the risk-benefit ratio before starting the treatment or during the same. Electrolyte abnormalities, low levels of serum potassium and several drugs may favour the acquired QT prolongation. Treatment of marked QT prolongation includes cardiac monitoring, caution in the use or suspension of cancer drugs and correction of electrolyte abnormalities (hypokalaemia, hypomagnesaemia, hypocalcaemia). Syndrome of QT prolongation can be associated with potentially fatal cardiac arrhythmias and its treatment consists of intravenous administration of magnesium sulphate and the use of electrical cardioversion.
PMID
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Authors

Mayor MeshTerms
Keywords

Anticancer drugs

Cardiotoxicity

QT prolongation

Target therapy

Journal Title cancer treatment reviews
Publication Year Start




PMID- 29304463
OWN - NLM
STAT- Publisher
LR  - 20180105
IS  - 1532-1967 (Electronic)
IS  - 0305-7372 (Linking)
VI  - 63
DP  - 2017 Dec 6
TI  - Management of QT prolongation induced by anti-cancer drugs: Target therapy and
      old agents. Different algorithms for different drugs.
PG  - 135-143
LID - S0305-7372(17)30201-3 [pii]
LID - 10.1016/j.ctrv.2017.11.009 [doi]
AB  - The side effects of anticancer drugs still play a critical role in survival and
      quality of life. Although the recent progresses of cancer therapies have
      significantly improved the prognosis of oncologic patients, side effects of
      antineoplastic treatments are still responsible for the increased mortality of
      cancer survivors. Cardiovascular toxicity is the most dangerous adverse effect
      induced by anticancer therapies. A survey conducted by the National Health and
      Nutrition Examination, showed that 1807 cancer survivors followed up for seven
      years: 51% died of cancer and 33% of heart disease (Vejpongsa and Yeh, 2014).
      Moreover, the risk of cardiotoxicity persists even with the targeted therapy, the
      newer type of cancer treatment, due to the presence of on-target and off-target
      effects related to this new class of drugs. The potential cardiovascular toxicity
      of anticancer agents includes: QT prolongation, arrhythmias, myocardial ischemia,
      stroke, hypertension (HTN), thromboembolism, left ventricular dysfunction and
      heart failure (HF). Compared to other cardiovascular disorders, the interest in
      QT prolongation and its complications is fairly recent. However, oncologists have
      to deal with it and to evaluate the risk-benefit ratio before starting the
      treatment or during the same. Electrolyte abnormalities, low levels of serum
      potassium and several drugs may favour the acquired QT prolongation. Treatment of
      marked QT prolongation includes cardiac monitoring, caution in the use or
      suspension of cancer drugs and correction of electrolyte abnormalities
      (hypokalaemia, hypomagnesaemia, hypocalcaemia). Syndrome of QT prolongation can
      be associated with potentially fatal cardiac arrhythmias and its treatment
      consists of intravenous administration of magnesium sulphate and the use of
      electrical cardioversion.
CI  - Copyright (c) 2017 The Author(s). Published by Elsevier Ltd.. All rights
      reserved.
FAU - Coppola, Carmela
AU  - Coppola C
AD  - Division of Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, 
      Naples, Italy.
FAU - Rienzo, Anna
AU  - Rienzo A
AD  - Division of Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, 
      Naples, Italy.
FAU - Piscopo, Giovanna
AU  - Piscopo G
AD  - Division of Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, 
      Naples, Italy.
FAU - Barbieri, Antonio
AU  - Barbieri A
AD  - Animal Facility Unit, Department of Translational Research, Istituto Nazionale
      Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy.
FAU - Arra, Claudio
AU  - Arra C
AD  - Animal Facility Unit, Department of Translational Research, Istituto Nazionale
      Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy.
FAU - Maurea, Nicola
AU  - Maurea N
AD  - Division of Cardiology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, 
      Naples, Italy. Electronic address: [email protected]
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20171206
PL  - Netherlands
TA  - Cancer Treat Rev
JT  - Cancer treatment reviews
JID - 7502030
OTO - NOTNLM
OT  - Anticancer drugs
OT  - Cardiotoxicity
OT  - QT prolongation
OT  - Target therapy
EDAT- 2018/01/06 06:00
MHDA- 2018/01/06 06:00
CRDT- 2018/01/06 06:00
PHST- 2017/06/29 00:00 [received]
PHST- 2017/11/20 00:00 [revised]
PHST- 2017/11/21 00:00 [accepted]
PHST- 2018/01/06 06:00 [entrez]
PHST- 2018/01/06 06:00 [pubmed]
PHST- 2018/01/06 06:00 [medline]
AID - S0305-7372(17)30201-3 [pii]
AID - 10.1016/j.ctrv.2017.11.009 [doi]
PST - aheadofprint
SO  - Cancer Treat Rev. 2017 Dec 6;63:135-143. doi: 10.1016/j.ctrv.2017.11.009.