Allongement de l'intervalle QT secondaire aux inhibiteurs des tyrosines-kinases.

Tyrosine kinase inhibitors (TKIs) are part of a growing class of treatments, the prescription of which has seen an increase with the identification of new targets and new drugs constantly being given marketing approval. The most common adverse effects are gastrointestinal and skinrelated. Cardiovascular effects are less well documented, because clinical signs are uncommon and their treatment remains underused: myocardial ischemia, hypertension and prolongation of the QT interval. Screening of QT interval is not common in clinical pratice, due to the lack of systematic electrocardiograms (ECGs). However, it is a potentially fatal complication, in case of torsade de pointes which may result in ventricular fibrillation. This toxicity is well documented for vandetanib, vemurafenib, sunitinib, sorafenib, nilotinib and crizotinib. QT interval prolongation is probable for lapatinib, erlotinib, dasatinib and bosutinib. Other TKIs are probably not responsible for QT interval prolongation but most of them have not been prescribed long enough to have a good idea. A baseline ECG is therefore recommended. Furthermore, particular attention should be paid to other medicinal products prescribed in oncology; first and foremost the numerous drugs used to provide supportive care that can prolong the QT interval, and to a lesser extent other molecules metabolised by cytochrome 3A4 that can increase or decrease plasma TKI levels. Cooperation between oncologists, haematologists and cardiologists is therefore needed. This is why a heart, vascular and cancer platform has been set up in the PACA region, in order to optimise patient care and prevent cardiovascular complications. [ABSTRACT FROM AUTHOR]