Nedaplatin induced QT prolongation with polymorphic ventricular tachyarrhythmia: clinical experience and review of literature

Nedaplatin (NDP), a cisplatin derivative, is widely employed in the treatment of solid tumours. Commonly reported adverse effects include hypersensitivity, myelosuppression and nephrotoxicity. To date, QT-interval prolongation and polymorphic ventricular tachyarrhythmia have not been attributed to NDP. A 41-year-old Asian woman was referred to our institution with abdominal pain, diarrhoea and vomiting. Percutaneous biopsy confirmed a diagnosis of high-grade serous carcinoma with widespread metastatic dissemination. She sequentially received a PD-1 inhibitor, paclitaxel and NDP. Twenty minutes after NDP infusion commenced she developed abdominal pain, palpitations, nausea and hypotension (68/39 mmHg). ECG disclosed marked QT prolongation, polymorphic ventricular tachycardia and Mobitz type I second-degree atrioventricular block. Advanced life-support measures were instituted immediately. Following withdrawal of the implicated agent and substitution with carboplatin, she remained asymptomatic during 48 h of monitoring. We report the case of marked QT-interval prolongation and polymorphic ventricular tachycardia temporally related to NDP administration. Clinicians should therefore monitor the electrocardiogram closely during NDP therapy, particularly in patients receiving polypharmacy.