Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy
ObjectiveThe management of cardiotoxicity concerning the use of oral antineoplastic agents (OAAs) is a challenge for healthcare professionals. Our objective was to create a comprehensive medication management guide with dose adjustment recommendations on OAAs concerning cardiotoxic and lipid metabol...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1220305/full |
| _version_ | 1797737013152055296 |
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| author | Elena Ramos-Ruperez Vicente Escudero-Vilaplana Vicente Escudero-Vilaplana Paula Ruiz-Briones Paula Ruiz-Briones Roberto Collado-Borrell Roberto Collado-Borrell Cristina Villanueva-Bueno Cristina Villanueva-Bueno José Luis Revuelta-Herrero José Luis Revuelta-Herrero Eva González-Haba Eva González-Haba Xandra Garcia-Gonzalez Xandra Garcia-Gonzalez Sara Ibañez-Garcia Sara Ibañez-Garcia Sara Perez-Ramirez Sara Perez-Ramirez Eduardo Zatarain-Nicolás Eduardo Zatarain-Nicolás Eduardo Zatarain-Nicolás Eduardo Zatarain-Nicolás Ana Herranz Ana Herranz María Sanjurjo María Sanjurjo |
| author_facet | Elena Ramos-Ruperez Vicente Escudero-Vilaplana Vicente Escudero-Vilaplana Paula Ruiz-Briones Paula Ruiz-Briones Roberto Collado-Borrell Roberto Collado-Borrell Cristina Villanueva-Bueno Cristina Villanueva-Bueno José Luis Revuelta-Herrero José Luis Revuelta-Herrero Eva González-Haba Eva González-Haba Xandra Garcia-Gonzalez Xandra Garcia-Gonzalez Sara Ibañez-Garcia Sara Ibañez-Garcia Sara Perez-Ramirez Sara Perez-Ramirez Eduardo Zatarain-Nicolás Eduardo Zatarain-Nicolás Eduardo Zatarain-Nicolás Eduardo Zatarain-Nicolás Ana Herranz Ana Herranz María Sanjurjo María Sanjurjo |
| author_sort | Elena Ramos-Ruperez |
| collection | DOAJ |
| description | ObjectiveThe management of cardiotoxicity concerning the use of oral antineoplastic agents (OAAs) is a challenge for healthcare professionals. Our objective was to create a comprehensive medication management guide with dose adjustment recommendations on OAAs concerning cardiotoxic and lipid metabolic adverse events (AEs) to assist healthcare professionals when prescribing OAAs.Materials and methodsA review of the available information on all dose adjustments necessary to safely prescribe and dispense OAAs concerning cardiotoxicity was conducted. In January 2023, we identified all OAAs authorized by the European Medicines Agency (EMA). For each drug, the latest summary of product characteristics (SPC) approved by the EMA and the tertiary data source Lexicomp® were reviewed. Cardiotoxic AEs were recorded, namely, QT interval prolongation, decrease in left ventricular ejection fraction (LVEF), imbalances in blood pressure (hypertension and hypotension), alterations in heart rate (tachycardia and bradycardia), and thrombosis. Any available dose adjustment recommendations in case of an occurrence of these adverse events were collected.ResultsIn all, 93 different OAAs had been approved by the EMA and were reviewed. Among them, 51.6% have recognized cardiotoxic AEs and 10.8% can cause alterations in lipid metabolism. A total of 27 (29.0%) OAAs had specific recommendations regarding QT prolongation; 88.9% were listed in the SPC and 59.3% in Lexicomp®. Eight OAAs (9.68%) have reported a decrease in LVEF, and four of these drugs, namely, encorafenib, lorlatinib, ripretinib, and sunitinib, have specific management recommendations. Almost half (49.5%) of currently approved OAAs can potentially alter blood pressure; 34 (36.6%) of them have been reported to cause hypertension and 12 (12.9%) are related to hypotension. Tachycardia and/or bradycardia are associated with 22.6% and 8.6% of the evaluated drugs, respectively. Regarding thrombosis, 30 (32.3%) of the drugs analyzed included the appearance of a thrombus as a possible AE.ConclusionsMore than half of the OAAs can produce cardiotoxic effects, with the most frequent being blood pressure alteration and QT interval prolongation with a non-depreciable incidence of LV dysfunction or thrombosis. Before starting the treatment, it is necessary to stratify baseline cardiovascular risk, plan a surveillance schedule, and consider referral to cardio-oncology units. |
| first_indexed | 2024-03-12T13:22:14Z |
| format | Article |
| id | doaj.art-53a5cf4d22e14290a294cade5ade3733 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-12T13:22:14Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-53a5cf4d22e14290a294cade5ade37332023-08-25T17:48:01ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-08-011310.3389/fonc.2023.12203051220305Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapyElena Ramos-Ruperez0Vicente Escudero-Vilaplana1Vicente Escudero-Vilaplana2Paula Ruiz-Briones3Paula Ruiz-Briones4Roberto Collado-Borrell5Roberto Collado-Borrell6Cristina Villanueva-Bueno7Cristina Villanueva-Bueno8José Luis Revuelta-Herrero9José Luis Revuelta-Herrero10Eva González-Haba11Eva González-Haba12Xandra Garcia-Gonzalez13Xandra Garcia-Gonzalez14Sara Ibañez-Garcia15Sara Ibañez-Garcia16Sara Perez-Ramirez17Sara Perez-Ramirez18Eduardo Zatarain-Nicolás19Eduardo Zatarain-Nicolás20Eduardo Zatarain-Nicolás21Eduardo Zatarain-Nicolás22Ana Herranz23Ana Herranz24María Sanjurjo25María Sanjurjo26San Pablo Centro de Estudios Universitarios (CEU), University, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainMedical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainCardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, SpainComplutense University, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainPharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainObjectiveThe management of cardiotoxicity concerning the use of oral antineoplastic agents (OAAs) is a challenge for healthcare professionals. Our objective was to create a comprehensive medication management guide with dose adjustment recommendations on OAAs concerning cardiotoxic and lipid metabolic adverse events (AEs) to assist healthcare professionals when prescribing OAAs.Materials and methodsA review of the available information on all dose adjustments necessary to safely prescribe and dispense OAAs concerning cardiotoxicity was conducted. In January 2023, we identified all OAAs authorized by the European Medicines Agency (EMA). For each drug, the latest summary of product characteristics (SPC) approved by the EMA and the tertiary data source Lexicomp® were reviewed. Cardiotoxic AEs were recorded, namely, QT interval prolongation, decrease in left ventricular ejection fraction (LVEF), imbalances in blood pressure (hypertension and hypotension), alterations in heart rate (tachycardia and bradycardia), and thrombosis. Any available dose adjustment recommendations in case of an occurrence of these adverse events were collected.ResultsIn all, 93 different OAAs had been approved by the EMA and were reviewed. Among them, 51.6% have recognized cardiotoxic AEs and 10.8% can cause alterations in lipid metabolism. A total of 27 (29.0%) OAAs had specific recommendations regarding QT prolongation; 88.9% were listed in the SPC and 59.3% in Lexicomp®. Eight OAAs (9.68%) have reported a decrease in LVEF, and four of these drugs, namely, encorafenib, lorlatinib, ripretinib, and sunitinib, have specific management recommendations. Almost half (49.5%) of currently approved OAAs can potentially alter blood pressure; 34 (36.6%) of them have been reported to cause hypertension and 12 (12.9%) are related to hypotension. Tachycardia and/or bradycardia are associated with 22.6% and 8.6% of the evaluated drugs, respectively. Regarding thrombosis, 30 (32.3%) of the drugs analyzed included the appearance of a thrombus as a possible AE.ConclusionsMore than half of the OAAs can produce cardiotoxic effects, with the most frequent being blood pressure alteration and QT interval prolongation with a non-depreciable incidence of LV dysfunction or thrombosis. Before starting the treatment, it is necessary to stratify baseline cardiovascular risk, plan a surveillance schedule, and consider referral to cardio-oncology units.https://www.frontiersin.org/articles/10.3389/fonc.2023.1220305/fulladverse eventcancercardiologycardiotoxicityoral antineoplastic therapysafety |
| spellingShingle | Elena Ramos-Ruperez Vicente Escudero-Vilaplana Vicente Escudero-Vilaplana Paula Ruiz-Briones Paula Ruiz-Briones Roberto Collado-Borrell Roberto Collado-Borrell Cristina Villanueva-Bueno Cristina Villanueva-Bueno José Luis Revuelta-Herrero José Luis Revuelta-Herrero Eva González-Haba Eva González-Haba Xandra Garcia-Gonzalez Xandra Garcia-Gonzalez Sara Ibañez-Garcia Sara Ibañez-Garcia Sara Perez-Ramirez Sara Perez-Ramirez Eduardo Zatarain-Nicolás Eduardo Zatarain-Nicolás Eduardo Zatarain-Nicolás Eduardo Zatarain-Nicolás Ana Herranz Ana Herranz María Sanjurjo María Sanjurjo Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy Frontiers in Oncology adverse event cancer cardiology cardiotoxicity oral antineoplastic therapy safety |
| title | Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy |
| title_full | Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy |
| title_fullStr | Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy |
| title_full_unstemmed | Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy |
| title_short | Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy |
| title_sort | medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy |
| topic | adverse event cancer cardiology cardiotoxicity oral antineoplastic therapy safety |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1220305/full |
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