PMID- 37692846 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230913 IS - 2234-943X (Print) IS - 2234-943X (Electronic) IS - 2234-943X (Linking) VI - 13 DP - 2023 TI - Medication guide for dose adjustment and management of cardiotoxicity and lipid metabolic adverse events of oral antineoplastic therapy. PG - 1220305 LID - 10.3389/fonc.2023.1220305 [doi] LID - 1220305 AB - OBJECTIVE: The 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 METHODS: A 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((R)) 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. RESULTS: In 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((R)). 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. CONCLUSIONS: More 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. CI - Copyright (c) 2023 Ramos-Ruperez, Escudero-Vilaplana, Ruiz-Briones, Collado-Borrell, Villanueva-Bueno, Revuelta-Herrero, Gonzalez-Haba, Garcia-Gonzalez, Ibanez-Garcia, Perez-Ramirez, Zatarain-Nicolas, Herranz and Sanjurjo. FAU - Ramos-Ruperez, Elena AU - Ramos-Ruperez E AD - San Pablo Centro de Estudios Universitarios (CEU), University, Madrid, Spain. FAU - Escudero-Vilaplana, Vicente AU - Escudero-Vilaplana V AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. FAU - Ruiz-Briones, Paula AU - Ruiz-Briones P AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. FAU - Collado-Borrell, Roberto AU - Collado-Borrell R AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. FAU - Villanueva-Bueno, Cristina AU - Villanueva-Bueno C AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. FAU - Revuelta-Herrero, Jose Luis AU - Revuelta-Herrero JL AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. FAU - Gonzalez-Haba, Eva AU - Gonzalez-Haba E AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. FAU - Garcia-Gonzalez, Xandra AU - Garcia-Gonzalez X AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. FAU - Ibanez-Garcia, Sara AU - Ibanez-Garcia S AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. FAU - Perez-Ramirez, Sara AU - Perez-Ramirez S AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. AD - Medical Oncology Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. FAU - Zatarain-Nicolas, Eduardo AU - Zatarain-Nicolas E AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. AD - Cardiology Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain. AD - Complutense University, Madrid, Spain. FAU - Herranz, Ana AU - Herranz A AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. FAU - Sanjurjo, Maria AU - Sanjurjo M AD - Pharmacy Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. AD - Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain. LA - eng PT - Journal Article DEP - 20230825 PL - Switzerland TA - Front Oncol JT - Frontiers in oncology JID - 101568867 PMC - PMC10485602 OTO - NOTNLM OT - adverse event OT - cancer OT - cardiology OT - cardiotoxicity OT - oral antineoplastic therapy OT - safety COIS- VE-V received support for continuing education/advisory fees from Amgen, Astellas, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Merck Sharp & Dohme, Novartis, Roche, Sanofi, and Sobi outside the submitted work; RC-B received support for continuing education/advisory fees from Amgen, Astellas, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Merck Sharp & Dohme, Novartis, and Roche outside the submitted work. XG-G received support for continuing education/advisory fees from Amgen, Astellas, and Galapagos outside the submitted work. EZ-N received support for continuing education/advisory fees from AstraZeneca and Bayer outside the submitted work. AH received support for continuing education/advisory fees from Kern and Janssen outside the submitted work. MS received support for continuing education/advisory fees from Janssen, Roche, and Amgen outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2023/09/11 06:42 MHDA- 2023/09/11 06:43 PMCR- 2023/01/01 CRDT- 2023/09/11 04:43 PHST- 2023/05/10 00:00 [received] PHST- 2023/08/02 00:00 [accepted] PHST- 2023/09/11 06:43 [medline] PHST- 2023/09/11 06:42 [pubmed] PHST- 2023/09/11 04:43 [entrez] PHST- 2023/01/01 00:00 [pmc-release] AID - 10.3389/fonc.2023.1220305 [doi] PST - epublish SO - Front Oncol. 2023 Aug 25;13:1220305. doi: 10.3389/fonc.2023.1220305. eCollection 2023.