Anticancer drugs-related QTc prolongation, torsade de pointes and sudden death: current evidence and future research perspectives
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Jialin Duan1, Jingwen Tao1, Maocai Zhai1, Chengpeng Li2, Ning Zhou1, Jiagao Lv1, Lin Wang1, Li Lin1 and Rong Bai3,4
1Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
2Department of Cardiology, Wuhan Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, P.R. China
3Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, P.R. China
4Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX, USA
Li Lin, email: [email protected]
Rong Bai, email: [email protected]
Keywords: anticancer therapy; QT interval prolongation; torsade de pointes; molecularly targeted drugs
Received: June 01, 2017 Accepted: March 13, 2018 Published: May 22, 2018
Anticancer drugs may have proarrhythmic effects including drug-induced QT interval prolongation, which is of particular importance because it can lead to a fatal polymorphic ventricular tachycardia termed torsade de pointes (TdP). QT interval prolongation and TdP are rare life-threatening untoward effects of anticancer therapy, particularly with arsenic trioxides and anthracyclines, and even some novel molecular targeted drugs touted as ‘tumor specific’. Several factors that affect myocardial repolarization can further increase the risk of TdP. This article reviews the mechanism of QT interval prolongation, risk factors for TdP and the QT toxicity of anticancer drugs as well as its management. Specific attention should be paid to high-risk populations such as patients with underlying heart diseases, electrolyte imbalance and bradycardia. To minimize the occurrence of QT interval prolongation and TdP, it is advisable to conduct a careful risk factor assessment before antitumor therapy. To this end, several new biomarkers have been introduced to predict TdP triggering and recent studies have pointed out the potential clinical relevance of genetic testing.
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