Evaluation of QTc interval prolongation in patients with advanced clear cell renal cell carcinoma treated with first line sunitinib
QTc prolongation was frequent and occurred both early and later during therapy.
Sunitinib, a multitargeted tyrosine kinase inhibitor, is used in advanced clear cell renal cell carcinoma (ccRCC). Corrected QT interval (QTc) prolongation is a recognized cardiovascular toxicity of this therapy. To evaluate the incidence, timing, and severity of QTc prolongation in real‑world advanced ccRCC patients treated with first‑line sunitinib, compare Bazett’s and Fridericia’s correction formulas, and identify risk factors. This retrospective single‑center cohort study included 67 patients between January 2019 and June 2022. QTc was calculated manually using Bazett’s and Fridericia’s formulas and graded per Common Terminology Criteria for Adverse Events (CTCAE) v5.0. The incidence, timing, and severity of QTc prolongation were assessed based on the highest recorded QTc value. QTc prolongation ≥ 450 ms occurred in 44.8% of patients (Bazett) and 34.3% (Fridericia) and ≥ 500 ms in 7 and 6 patients, respectively. The median onset of QTc ≥ 450 ms was cycle 7.9 (Bazett) and 10.4 (Fridericia). Bazett’s values were significantly higher across most treatment cycles (p < 0.05). Older age, thyroid dysfunction, smoking history, hypertension and soft‑tissue metastases were associated with increased risk of QTc prolongation. QTc prolongation was frequent and occurred both early and later during therapy. Fridericia’s formula provided more accurate and stable values and should be preferred for monitoring. Repeated ECG measurements and close cardio‑oncology collaboration are essential.
Frequent QTc prolongation indicates a significant cardiovascular risk in patients with advanced clear cell renal cell carcinoma treated with first‑line sunitinib. Early detection and monitoring using a reliable correction formula (Fridericia) can prevent potentially fatal arrhythmias and guide treatment modification, thereby improving patient safety and treatment outcomes.
Evidence level: Sejtvonalas. Laboratóriumi sejtekben vizsgálták.
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