QT Prolongation and Arrhythmias in Cancer Therapy: A Narrative Review of Mechanistic and Clinical Studies - PubMed
4 hours ago
- #Drug interactions
- #QT prolongation
- #Cardio-oncology
- QTc prolongation and arrhythmias are major preventable risks in cancer therapy, involving drugs like arsenic trioxide, vandetanib, nilotinib, sunitinib, and ribociclib.
- Mechanisms include direct hERG/IKr blockade, PI3K/Akt pathway modulation, and indirect factors like cytokine-mediated myocarditis, electrolyte issues, and structural remodeling.
- Polypharmacy and drug interactions (e.g., with fluoroquinolones, azole antifungals, antiemetics) amplify risk; safer alternatives include beta-lactams, echinocandins, and palonosetron.
- A clinical framework involves baseline ECG/electrolyte checks, QT-risk stratification, and intervention thresholds (QTc ≥ 500 ms or increase ≥ 60 ms).
- Acute management of torsades de pointes includes IV magnesium and overdrive pacing, plus structured hold-and-rechallenge algorithms.
- System-level strategies like drug interaction stewardship and clinician education aim to shift from reactive to preventive cardio-oncology care.