Haux J, Klepp O, Spigset O, Tretli S
Department of Oncology, University Hospital, N-7006, Trondheim, Norway.
BMC Cancer. 2001;1:11. doi: 10.1186/1471-2407-1-11. Epub 2001 Aug 10.
Digitoxin induces apoptosis in different human malignant cell lines in vitro. In this paper we investigated if patients taking digitoxin for cardiac disease have a different cancer incidence compared to the general population.
Computer stored data on digitoxin concentrations in plasma from 9271 patients with cardiac disease were used to define a user population. Age and sex matched controls from the Norwegian Cancer Registry were used to calculate the number of expected cancer cases.
The population on digitoxin showed a higher incidence of cancer compared to the control population. However, an additional analysis showed that the population on digitoxin had a general increased risk of cancer already, before the start on digitoxin. Leukemia/lymphoma were the cancer types which stood out with the highest risk in the digitoxin population before starting on digitoxin. This indicates that yet unknown risk factors exist for cardiovascular disease and lymphoproliferative cancer. An internal dose-response analysis revealed a relationship between high plasma concentration of digitoxin and a lower risk for leukemia/lymphoma and for cancer of the kidney/urinary tract.
Morbidity and mortality are high in the population on digitoxin, due to high age and cardiac disease. These factors disturb efforts to isolate an eventual anticancer effect of digitoxin in this setting. Still, the results may indicate an anticancer effect of digitoxin for leukemia/lymphoma and kidney/urinary tract cancers. Prospective clinical cancer trials have to be done to find out if digitoxin and other cardiac glycosides are useful as anticancer agents.
洋地黄毒苷在体外可诱导不同人类恶性细胞系发生凋亡。在本文中，我们研究了因心脏病服用洋地黄毒苷的患者与普通人群相比，癌症发病率是否存在差异。
利用计算机存储的9271例心脏病患者血浆中洋地黄毒苷浓度的数据来确定研究人群。使用来自挪威癌症登记处年龄和性别匹配的对照来计算预期癌症病例数。
服用洋地黄毒苷的人群与对照人群相比，癌症发病率更高。然而，进一步分析表明，服用洋地黄毒苷的人群在开始服用洋地黄毒苷之前就已经普遍存在患癌风险增加的情况。白血病/淋巴瘤是在开始服用洋地黄毒苷之前，服用洋地黄毒苷人群中风险最高的癌症类型。这表明心血管疾病和淋巴增殖性癌症存在尚未明确的风险因素。内部剂量反应分析显示，血浆洋地黄毒苷浓度高与白血病/淋巴瘤以及肾脏/泌尿系统癌症风险较低之间存在关联。
由于年龄较大和患有心脏病，服用洋地黄毒苷的人群发病率和死亡率较高。这些因素干扰了在此背景下分离洋地黄毒苷最终抗癌作用的努力。尽管如此，结果可能表明洋地黄毒苷对白血病/淋巴瘤以及肾脏/泌尿系统癌症具有抗癌作用。必须进行前瞻性临床癌症试验，以确定洋地黄毒苷和其他强心苷是否可用作抗癌药物。
