The QT interval prolongation potential of anticancer and supportive drugs: a comprehensive overview.

Patients with cancer are prone to prolongation of the corrected QT interval (QTc) due to the use of anticancer drugs with QTc-prolonging potential in combination with electrolyte imbalances caused by, for example, gastrointestinal side-effects. However, most anticancer drugs were approved with little information on their QTc-prolonging potential and the added risk of torsade de pointes. The absence of this information on the drug label poses a considerable challenge to clinicians regarding the measures that need to be taken to safely start anticancer treatment. In this Review, we provide a comprehensive overview of the evidence for the QTc-prolonging properties of 205 anticancer drugs and 14 antiemetic drugs available from drug labels, assessment reports, and published studies. We classify the drugs as low-risk, moderate-risk, or high-risk for QTc prolongation. We also discuss the clinical relevance of these findings and include practical recommendations to guide clinicians to select the drugs with the least QTc-prolonging properties and to adequately monitor susceptible patients.

[Medication safety in trials is not sufficiently guaranteed]. / Medicatieveiligheid in trials onvoldoende gewaarborgd.

We suspected that safety of medication in clinical studies is not sufficiently guaranteed, despite a variety of safety nets. In order to check whether this suspicion is correct, we conducted a retrospective analysis of 75 patients enrolled in 11 clinical studies conducted at our hospital in the last couple of years. We focused specifically on the number of clinically relevant interactions between study medication and concomitant medication and on the information in the study protocol to prevent such interactions. Our analysis showed that approximately 45% of study participants experienced at least one clinically relevant interaction and that not a single study protocol provided sufficient information to prevent interactions with study medication. This means that study participants are at risk to experience unnecessary adverse effects caused by interaction of medicines. In this article, we give recommendations to improve medication safety in clinical studies.