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Beavers CJ, Rodgers JE, Bagnola AJ, Beckie TM, Campia U, Di Palo KE, Okwuosa TM, Przespolewski ER, Dent S. Cardio-Oncology Drug Interactions: A Scientific Statement From the American Heart Association. Circulation 2022; 145:e811-e838. [PMID: 35249373 DOI: 10.1161/cir.0000000000001056] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In the cardio-oncology population, drug interactions are of particular importance given the complex pharmacological profile, narrow therapeutic index, and inherent risk of therapies used to manage cardiovascular disease and cancer. Drug interactions may be beneficial or detrimental to the desired therapeutic effect. Clinicians in both cardiology and oncology should be cognizant of these potential drug-drug interactions that may reduce the efficacy or safety of either cardiovascular or cancer therapies. These risks can be mitigated through increased recognition of potential drug-drug interaction, use of alternative medications when possible, and careful monitoring. This scientific statement provides clinicians with an overview of pharmacodynamic and pharmacokinetic drug-drug interactions in patients with cancer exposed to common cardiovascular and cancer medications.
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Peng X, Chen J, Li L, Sun Z, Liu J, Ren Y, Huang J, Chen J. Efficient Synthesis and Bioevaluation of Novel Dual Tubulin/Histone Deacetylase 3 Inhibitors as Potential Anticancer Agents. J Med Chem 2021; 64:8447-8473. [PMID: 34097389 DOI: 10.1021/acs.jmedchem.1c00413] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Novel dual HDAC3/tubulin inhibitors were designed and efficiently synthesized by combining the pharmacophores of SMART (tubulin inhibitor) and MS-275 (HDAC inhibitor), among which compound 15c was found to be the most potent and balanced HDAC3/tubulin dual inhibitor with high HDAC3 activity (IC50 = 30 nM) and selectivity (SI > 1000) as well as excellent antiproliferative potency against various cancer cell lines, including an HDAC-resistant gastric cancer cell line (YCC3/7) with IC50 values in the range of 30-144 nM. Compound 15c inhibited B16-F10 cancer cell migration and colony formation. In addition, 15c demonstrated significant in vivo antitumor efficacy in a B16-F10 melanoma tumor model with a better TGI (70.00%, 10 mg/kg) than that of the combination of MS-275 and SMART. Finally, 15c presented a safe cardiotoxicity profile and did not cause nephro-/hepatotoxicity. Collectively, this work shows that compound 15c represents a novel tubulin/HDAC3 dual-targeting agent deserving further investigation as a potential anticancer agent.
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Affiliation(s)
- Xiaopeng Peng
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Jingxuan Chen
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Ling Li
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Zhiqiang Sun
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Jin Liu
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Yichang Ren
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Junli Huang
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Jianjun Chen
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
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Evaluation of Cardiac Repolarization in the Randomized Phase 2 Study of Intermediate- or High-Risk Smoldering Multiple Myeloma Patients Treated with Daratumumab Monotherapy. Adv Ther 2021; 38:1328-1341. [PMID: 33474705 PMCID: PMC7889563 DOI: 10.1007/s12325-020-01601-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022]
Abstract
Introduction Daratumumab is a CD38-targeting monoclonal antibody that has demonstrated clinical benefit for multiple myeloma. Daratumumab inhibition of CD38, which is expressed on immune cell populations and cardiomyocytes, could potentially affect cardiac function. This QTc substudy of the phase 2 CENTAURUS study investigated the potential effect of intravenous daratumumab monotherapy on QTc prolongation and other electrocardiogram (ECG) parameters, including concentration-QTc effect modeling. Methods Patients had intermediate- or high-risk smoldering multiple myeloma. Patients with QT interval corrected by Fridericia’s formula (QTcF) > 470 ms, QRS interval ≥ 110 ms, or PR interval ≥ 200 ms were excluded. Triplicate ECGs were collected at screening, Dose 1, and Dose 8. Analyses of on-treatment ECGs were conducted with a time-matched baseline (primary analysis). By time-point, pharmacokinetic-pharmacodynamic (PK/PD), and outlier analyses were conducted. Results Of 123 patients in CENTAURUS, 31 were enrolled in the QTc substudy. Daratumumab produced a small increase in heart rate (5–12 beats per minute) of unclear significance. There was a small but clinically insignificant effect on QTc, as measured by both time-matched time-point and PK/PD analyses. The primary analysis demonstrated a maximum mean increase in QTcF of 9.1 ms (90% 2-sided upper confidence interval [CI], 14.1 ms). The primary PK/PD analysis predicted a maximum QTcF increase of 8.5 ms (90% 2-sided upper CI, 13.5 ms). No patient had an abnormal U wave, a new QTcF > 500 ms, or > 60 ms change from baseline for QTcF. Conclusion Analysis of ECG intervals and concentration-QTc relationships showed a small but clinically insignificant effect of daratumumab. Trial Registration ClinicalTrials.gov Identifier: NCT02316106. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01601-w.
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Lysine acetyltransferases and lysine deacetylases as targets for cardiovascular disease. Nat Rev Cardiol 2019; 17:96-115. [DOI: 10.1038/s41569-019-0235-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 12/28/2022]
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Zhou M, Chen X, Zhang H, Xia L, Tong X, Zou L, Hao R, Pan J, Zhao X, Chen D, Song Y, Qi Y, Tang L, Liu Z, Gao R, Shi Y, Yang Z. China National Medical Products Administration approval summary: anlotinib for the treatment of advanced non-small cell lung cancer after two lines of chemotherapy. Cancer Commun (Lond) 2019; 39:36. [PMID: 31221221 PMCID: PMC6585030 DOI: 10.1186/s40880-019-0383-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/13/2019] [Indexed: 12/30/2022] Open
Abstract
Background On May 8, 2018, the China National Medical Products Administration (NMPA) approved anlotinib, an orally administered anti-angiogenesis inhibitor, for the treatment of patients with advanced non-small cell lung cancer (NSCLC) who have progressed after treatment with two or more lines of prior systemic chemotherapy. Main body of the abstract China NMPA reviewed and inspected a regional double-blinded, placebo-controlled, Phase III trial comparing the overall survival (OS) of NSCLC patients between the anlotinib and placebo arms. A total of 437 patients were randomized (2:1) to receive either anlotinib (n = 294) or placebo (n = 143) once daily on a 2-week on and 1-week off schedule. Patients with epidermal growth factor receptor (EGFR) or activating anaplastic lymphoma kinase (ALK) genomic tumor aberrations should have disease progression on NMPA-approved therapy. Anlotinib is the first NMPA-approved drug for patients with advanced NSCLC who have progressed on at least two lines of prior systemic chemotherapies in China. The approval was based on a statistically and clinically significant improvement in median OS with anlotinib (9.46 months) compared with placebo [6.37 months; hazard ratio (HR]) = 0.70, 95% confidence interval (CI) = 0.55–0.89; two-sided log-rank P = 0.002]. The confirmed objective response rate (ORR) was 9.2% in the anlotinib arm and 0.7% in the placebo arm. The median duration of response (DoR) was 4.83 months, with a 95% CI of 3.31–6.97 months. The toxicity profile of anlotinib was consistent with that of known anti-angiogenesis inhibitors. Common adverse drug reactions (ADRs) in anlotinib-treated patients included hypertension (67.4%), hand–foot syndrome (43.9%), hemoptysis (14.0%), thyroid stimulating hormone (TSH) elevation (46.6%), and corrected QT interval (QTc) prolongation (26.2%). Short conclusion Anlotinib demonstrated a clinically significant OS prolongation as a novel therapeutic option for advanced or metastatic NSCLC following at least two lines of chemotherapy.
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Affiliation(s)
- Ming Zhou
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Xiaoyuan Chen
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Hong Zhang
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Lin Xia
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Xin Tong
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Limin Zou
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Ruimin Hao
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Jianhong Pan
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Xiao Zhao
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Dongmei Chen
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Yuanyuan Song
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Yueli Qi
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Ling Tang
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Zhifang Liu
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China
| | - Rong Gao
- Center for Drug Inspection, China National Medical Products Administration, Beijing, 100037, P. R. China
| | - Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, P. R. China
| | - Zhimin Yang
- Medical Review Department 1, Center for Drug Evaluation, China National Medical Products Administration, No. 128 Jianguo Road, Chaoyang District, Beijing, 100022, P. R. China.
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QT Interval Prolongation Associated With Cytotoxic and Targeted Cancer Therapeutics. Curr Treat Options Oncol 2019; 20:55. [DOI: 10.1007/s11864-019-0657-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Guha A, Armanious M, Fradley MG. Update on cardio-oncology: Novel cancer therapeutics and associated cardiotoxicities. Trends Cardiovasc Med 2019; 29:29-39. [DOI: 10.1016/j.tcm.2018.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/22/2018] [Accepted: 06/03/2018] [Indexed: 02/08/2023]
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Alexandre J, Moslehi JJ, Bersell KR, Funck-Brentano C, Roden DM, Salem JE. Anticancer drug-induced cardiac rhythm disorders: Current knowledge and basic underlying mechanisms. Pharmacol Ther 2018; 189:89-103. [PMID: 29698683 DOI: 10.1016/j.pharmthera.2018.04.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Significant advances in cancer treatment have resulted in decreased cancer related mortality for many malignancies with some cancer types now considered chronic diseases. Despite these improvements, there is increasing recognition that many cancer patients or cancer survivors can develop cardiovascular diseases, either due to the cancer itself or as a result of anticancer therapy. Much attention has focused on heart failure; however, other cardiotoxicities, notably cardiac rhythm disorders, can occur without underlying cardiomyopathy. Supraventricular tachycardias occur in cancer patients treated with cytotoxic chemotherapy (anthracyclines, gemcitabine, cisplatin and alkylating-agents) or kinase-inhibitors (KIs) such as ibrutinib. Ventricular arrhythmias, with a subset of them being torsades-de-pointes (TdP) favored by QTc prolongation have been reported: this may be the result of direct hERG-channel inhibition or a more recently-described mechanism of phosphoinositide-3-kinase inhibition. The major anticancer drugs responsible for QTc prolongation in this context are KIs, arsenic trioxide, anthracyclines, histone deacetylase inhibitors, and selective estrogen receptor modulators. Anticancer drug-induced cardiac rhythm disorders remain an underappreciated complication even by experienced clinicians. Moreover, the causal relationship of a particular anticancer drug with cardiac arrhythmia occurrence remains challenging due in part to patient comorbidities and complex treatment regimens. For example, any cancer patient may also be diagnosed with common diseases such as hypertension, diabetes or heart failure which increase an individual's arrhythmia susceptibility. Further, anticancer drugs are generally usually used in combination, increasing the challenge around establishing causation. Thus, arrhythmias appear to be an underappreciated adverse effect of anticancer agents and the incidence, significance and underlying mechanisms are now being investigated.
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Affiliation(s)
- Joachim Alexandre
- CHU Caen, PICARO Cardio-oncology Program, Department of Pharmacology, F-14033 Caen, France; Normandie Univ, UNICAEN, CHU Caen, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, 14000 Caen, France
| | - Javid J Moslehi
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA
| | - Kevin R Bersell
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christian Funck-Brentano
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joe-Elie Salem
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France.
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Reduce the risk of QT interval prolongation associated with targeted cancer therapy by using arrhythmic risk stratification and prevention strategies. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0428-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Damrongwatanasuk R, Fradley MG. Cardiovascular Complications of Targeted Therapies for Chronic Myeloid Leukemia. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:24. [PMID: 28316033 DOI: 10.1007/s11936-017-0524-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OPINION STATEMENT The development of tyrosine kinase inhibitors (TKIs) dramatically changed the treatment landscape for many different cancers including chronic myeloid leukemia (CML). With the introduction of imatinib, the first TKI developed and approved to effectively treat CML, patient survival has increased dramatically and, in some cases, this fatal cancer can be managed as a chronic disease. Since the approval of imatinib in 2002, four additional TKIs have been developed to treat this disease including the second-generation TKIs nilotinib, dasatinib, and bosutinib and the third-generation TKI ponatinib. Despite their significant impact on the progression of CML, there is increasing recognition of cardiovascular toxicities which can limit their long-term use and impact patient morbidity and mortality. The majority of the cardiotoxicities are associated with the second- and third-generation TKIs, the most concerning of which are vascular events including myocardial infarction, stroke and peripheral arterial disease. In addition, QT prolongation, pleural effusions, and both systemic and pulmonary hypertension are also observed. It is essential for both cardiologists and oncologists to possess knowledge of these issues in order to develop appropriate monitoring and risk mitigation strategies to prevent these toxicities and avoid premature cessation of the drug.
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Affiliation(s)
- Rongras Damrongwatanasuk
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida and H. Lee Moffitt Cancer Center & Research Institute, 2 Tampa General Circle, Tampa, FL, 33606, USA
| | - Michael G Fradley
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida and H. Lee Moffitt Cancer Center & Research Institute, 2 Tampa General Circle, Tampa, FL, 33606, USA.
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Cuni R, Parrini I, Asteggiano R, Conte MR. Targeted Cancer Therapies and QT Interval Prolongation: Unveiling the Mechanisms Underlying Arrhythmic Complications and the Need for Risk Stratification Strategies. Clin Drug Investig 2017; 37:121-134. [PMID: 27638052 DOI: 10.1007/s40261-016-0460-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The care and treatment of cancer patients has significantly changed in the last decade with a remarkable shift towards novel targeted therapies. These promising new drugs may represent effective and potentially life-saving therapeutic options in cancer patients, but are also emerging in the cardiotoxicity scenario for their arrhythmogenic potential due to their QT-prolonging activity. In this article we review the mechanisms underlying drug-induced QT interval prolongation and the classes of anticancer-targeted therapies most frequently responsible for this adverse event, with a particular focus on tyrosine kinase-targeting molecules. Since up to 49 % of serious adverse drug reactions (ADRs) and 58 % of potentially fatal ADRs may not appear on initial drug safety labels, we also review and discuss data from the post-marketing VigiBase® safety reporting system, the World Health Organization's global database of ADRs. Finally, we discuss arrhythmic risk stratification and prevention strategies in the complex multiple-risk setting of cancer patients, paying particular attention to drug-drug interactions with common antimicrobial, psychotropic and antiemetic supportive care, and we also provide an electrocardiographic QT monitoring algorithm for patients who are candidates for targeted cancer therapies.
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Affiliation(s)
- Rezarta Cuni
- Department of Cardiology, Azienda Ospedaliera Ordine Mauriziano, Largo Filippo Turati nr. 62, 10128, Turin, Italy.
| | - Iris Parrini
- Department of Cardiology, Azienda Ospedaliera Ordine Mauriziano, Largo Filippo Turati nr. 62, 10128, Turin, Italy
| | - Riccardo Asteggiano
- Azienda Sanitaria Locale Torino 2 and Torino 3, Out of Hospital Cardiology Service, Turin, Italy
| | - Maria Rosa Conte
- Department of Cardiology, Azienda Ospedaliera Ordine Mauriziano, Largo Filippo Turati nr. 62, 10128, Turin, Italy
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Keller KL, Franquiz MJ, Duffy AP, Trovato JA. Drug–drug interactions in patients receiving tyrosine kinase inhibitors. J Oncol Pharm Pract 2016; 24:110-115. [DOI: 10.1177/1078155216682311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Rationale Tyrosine kinase inhibitors are increasingly used in the treatment of cancer. Drug interactions involving tyrosine kinase inhibitors are commonly encountered in clinical practice. The objective of this study was to describe the frequency of tyrosine kinase inhibitor-associated drug interactions among a cohort of oncology patients. Methods Adult patients were included who presented to either of two outpatient oncology practices and were prescribed a tyrosine kinase inhibitor during 2 January 2013 to 1 January 2015. Demographic and medication data were abstracted from electronic medical records. Lexicomp®, Micromedex Solutions®, and medication labeling were utilized to identify potential interactions between tyrosine kinase inhibitors and concomitant medications. Interactions were then assessed by the investigators for clinical significance. The primary outcome was the frequency of significant drug interactions involving tyrosine kinase inhibitors and concomitant medications. Secondary outcomes included describing the nature and clinical impact of interactions, and describing interactions by medication class. Results A total of 356 patients were identified for analysis, in whom 244 potential interactions were identified, and 109 (44.7%) of which were considered severe. Decreased tyrosine kinase inhibitor absorption due to acid suppressive therapy and CYP3A4 interactions were the most frequent mechanisms of potential subtherapeutic and supratherapeutic concentrations, respectively. Potential clinical consequences included QTc prolongation ( n = 53, 48.6%), decreased tyrosine kinase inhibitor concentration ( n = 53, 48.6%), and increased tyrosine kinase inhibitor concentration ( n = 3, 2.8%). Conclusions Safer alternative therapy and/or more frequent clinical monitoring should be considered if an interaction poses a significant risk of increased tyrosine kinase inhibitor toxicity or decreased tyrosine kinase inhibitor efficacy. Oncology pharmacists can play a role in screening for tyrosine kinase inhibitor-associated interactions, recommending alternative therapies or dosing strategies, and monitoring tyrosine kinase inhibitor efficacy and toxicity.
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Affiliation(s)
- Kristine L Keller
- Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Miguel J Franquiz
- Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Alison P Duffy
- Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, MD, USA
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - James A Trovato
- Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, MD, USA
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Viganego F, Singh R, Fradley MG. Arrhythmias and Other Electrophysiology Issues in Cancer Patients Receiving Chemotherapy or Radiation. Curr Cardiol Rep 2016; 18:52. [DOI: 10.1007/s11886-016-0730-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Fradley MG, Pinilla-Ibarz J. Arrhythmic complications of tyrosine kinase inhibitors. Future Cardiol 2015; 11:395-9. [DOI: 10.2217/fca.15.42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Michael G Fradley
- Division of Cardiovascular Medicine, University of South Florida, Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Javier Pinilla-Ibarz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Abstract
Many pharmaceutical agents interact with cardiac ion channels resulting in abnormal ventricular repolarization and prolongation of the QT interval. In rare circumstances, this has resulted in the development of the potentially life-threatening arrhythmia, torsades de pointes. It is recognized, however, that accurate measurement of the QT interval is challenging, and it is a poor predictor for the development of this arrhythmia. Nevertheless, QT interval monitoring is an essential part of pharmaceutical development, and significant increases in the QT interval may prevent a drug from gaining approval.
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Affiliation(s)
- Michael G Fradley
- Division of Cardiovascular Medicine, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA.
| | - Javid Moslehi
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2220 Pierce Avenue, Nashville, TN 37232, USA; Division of Hematology-Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2220 Pierce Avenue, Nashville, TN 37232, USA; Cardio-Oncology Program, Vanderbilt University School of Medicine, 2220 Pierce Avenue, Nashville, TN 37232, USA
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