Nursing Roles in Cardiac Safety: Romidepsin in Patients With T-Cell Lymphoma

Purpose/Objectives: To provide information to help nurses mitigate cardiac risks among patients receiving romidepsin (Istodax®), a histone deacetylase (HDAC) inhibitor approved by the U.S. Food and Drug Administration for the treatment of relapsed/refractory cutaneous and peripheral T-cell lymphoma.

Data Sources: Clinical studies of romidepsin represented the primary data sources. Supporting references included class information on HDAC inhibitors, as well as data regarding the impact of electrolyte imbalances and antiemetic treatment on electrocardiogram (ECG) data.

Data Synthesis: Cardiac concerns during treatment with romidepsin are multifactorial. Electrolyte deficiencies, which are associated with ECG abnormalities and dysrhythmias, are common among patients with T-cell lymphoma. In addition, clinically insignificant changes in the corrected QT interval reported with romidepsin are primarily attributable to concomitant use of prophylactic antiemetics and likely exaggerated by transient increases in heart rate.

Conclusions: Data support the cardiac safety of romidepsin while cautioning about the need for nurses’ vigilance regarding consistent electrolyte supplementation, appropriate antiemetic selection, and heart rate monitoring.

Implications for Nursing: By recognizing drug-related and non–drug-related influences on cardiac safety during treatment with romidepsin, as well as other anticancer agents, nurses can identify risks, report them, and recommend appropriate interventions, which, ultimately, facilitates improved patient outcomes.