Electrocardiographic effects of class 1 selective histone deacetylase inhibitor romidepsin

Romidepsin is a histone deacetylase inhibitor approved by the FDA for the treatment of patients with cutaneous or peripheral T‐cell lymphoma who have received prior systemic therapy. The objective of this analysis was to evaluate the potential QTc effects of romidepsin. Patients with advanced malignancy received 4‐h infusions of 14 mg/m2 romidepsin on days 1, 8, and 15 of a 28‐day cycle. In cycle 2, a subset of patients received 1‐h infusions of 8–12 mg/m2 romidepsin. Patients were administered antiemetics before each romidepsin dose and electrolyte supplementation as needed. Electrocardiogram readings were performed prior to antiemetic administration, prior to romidepsin administration, and at specified time points over the subsequent 24 h. Romidepsin exposure and heart rate were also assessed. In the electrocardiogram‐evaluable population, 26 patients received romidepsin at 14 mg/m2 over 4 h. The maximum mean increases from the preantiemetic baseline for QTcF and heart rate were 10.1 msec (upper 90% CI, 14.5 msec) and 18.2 beats per minute, respectively. No patient in this study had an absolute QTcF value >450 msec and only one patient had an increase from the preantiemetic baseline of >60 msec. There was a mild reduction in the PR interval and no meaningful changes in the QRS interval. Despite the use of QT‐prolonging antiemetics, treatment with romidepsin did not markedly prolong the QTc interval through 24 h. Increases in calculated QTc may have been exaggerated as a consequence of transient increases in heart rate. The available data support the absence of a major effect of romidepsin on the QTc interval. Administration of certain antiemetics and patient hypomagnesemia/hypokalemia can impact the QT interval, thus electrolyte levels should be kept in the normal range and consideration should be exercised when administering romidepsin with antiemetics and other drugs that prolong the QTc interval.