de Lemos Mário L, Kung Carrie, Kletas Victoria, Badry Nadine, Kang Isabell
Provincial Pharmacy, Systemic Therapy Program, BC Cancer Agency, Vancouver, BC, Canada.
J Oncol Pharm Pract. 2019 Jan;25(1):198-204. doi: 10.1177/1078155217748735. Epub 2018 Jan 3.
Since the introduction of regulatory drug approval guidance on the evaluation of QT interval prolongation, an increasing number of drug monographs has included cautions on the risk of QT prolongation. For example, QT prolongation is mentioned in the Canadian product monographs of 29 drugs commonly seen in oncology practice. This presents two major challenges. First, most guidelines and risk predictive tools for QT prolongation have been developed for hospitalized patients in acute care settings. In contrast, most QT-prolonging oncology drugs are used in medically stable patients in the ambulatory setting. Second, many oncology drugs are unique for their indications and non-QT prolonging alternative agents are often not available. In this review, we will outline an empiric initial approach to ambulatory cancer patients who are treated with oncology drugs which may prolong QT interval. This includes the predictive value of QT prolongation on torsades de pointes, the risk factors of the patients and the drugs, and the limitations of existing guidance in this area.
自从出台了关于QT间期延长评估的药品监管审批指南以来，越来越多的药品说明书加入了关于QT延长风险的警示。例如，加拿大肿瘤学实践中常见的29种药物的产品说明书中提到了QT延长。这带来了两大挑战。首先，大多数关于QT延长的指南和风险预测工具是针对急性护理环境中的住院患者开发的。相比之下，大多数延长QT间期的肿瘤学药物用于门诊环境中病情稳定的患者。其次，许多肿瘤学药物因其适应症而具有独特性，且通常没有非QT延长的替代药物。在本综述中，我们将概述一种针对接受可能延长QT间期的肿瘤学药物治疗的门诊癌症患者的经验性初始方法。这包括QT延长对尖端扭转型室速的预测价值、患者和药物的风险因素，以及该领域现有指南的局限性。
