Poprach A, Petráková K, Vyskocil J, Lakomý R, Nemecek R, Kocák I, Kocáková I, Vyzula R
Klinika Komplexní Onkologické Péce, Masarykův Onkologický Ustav Brno.
Klin Onkol. 2008;21(5):288-93.
Administration of cytotoxic drugs is accompanied by many serious side effects, with cardiac toxicity as one of the most dangerous. In clinical practice anthracyclines are the best known chemotherapeutic agents linked to cardiotoxicity, however there are a number of other anti-cancer drugs (cyclophosphamide, taxans, trastuzumab, 5-fluorouracil, imunomodulators etc) that may cause cardiac toxicity as well. Basic mechanism through which anthracylines cause cardiac damage is recognized, though many pathogenetic ways of their toxicity still remain to be elucidated. Administration of trastuzumab is also clearly associated with cardiotoxicity, however, depression of left ventricular ejection fraction (LVEF) caused by this agent (unlike anthacyclines) seems to be fully reversible. For monitoring cardiotoxicity we use several methods--biochemical examination, use of X-ray, radionuclides or ultrasound. The most commonly used method to identify patients with heart damage is echocardiography with clinical examination. When a cardiac damage (mostly congestive heart failure with low LVEF) occures, following treatment depends on clinical symptoms and LVEF. These patients are then treated according to common internal medecine recommendations. Several cardioprotective agents have been tested, among these dexarazoxane seems do show significant cardioprotective activity. Also liposomal encapsulation of anthacyclines may reduce heart damage, especially early cardiotoxicity. Cardiotoxicity of cytostatic agents is a very serious side effect of anti-cancer therapy, which may affect survival more than the malignancy itself. Therefore a concentrated effort should be expended to prevent cardiac damage or at least to its early identification and prompt treatment.
细胞毒性药物的使用伴随着许多严重的副作用，心脏毒性是最危险的副作用之一。在临床实践中，蒽环类药物是最广为人知的与心脏毒性相关的化疗药物，然而还有许多其他抗癌药物（环磷酰胺、紫杉烷类、曲妥珠单抗、5-氟尿嘧啶、免疫调节剂等）也可能导致心脏毒性。虽然蒽环类药物导致心脏损伤的基本机制已得到确认，但它们毒性的许多致病途径仍有待阐明。曲妥珠单抗的使用也明显与心脏毒性有关，然而，该药物引起的左心室射血分数（LVEF）降低（与蒽环类药物不同）似乎是完全可逆的。为了监测心脏毒性，我们使用几种方法——生化检查、X射线、放射性核素或超声检查。识别心脏损伤患者最常用的方法是超声心动图检查结合临床检查。当发生心脏损伤（主要是LVEF降低的充血性心力衰竭）时，后续治疗取决于临床症状和LVEF。然后根据普通内科的建议对这些患者进行治疗。已经测试了几种心脏保护剂，其中地拉罗司似乎显示出显著的心脏保护活性。蒽环类药物的脂质体包封也可能减少心脏损伤，尤其是早期心脏毒性。细胞毒性药物的心脏毒性是抗癌治疗非常严重的副作用，它对生存的影响可能超过恶性肿瘤本身。因此，应该集中精力预防心脏损伤，或者至少对其进行早期识别和及时治疗。
