Department of Medical Oncology, Hôpital Pitié Salpêtrière, Paris, France.
Crit Rev Oncol Hematol. 2010 Dec;76(3):186-95. doi: 10.1016/j.critrevonc.2010.01.012. Epub 2010 Feb 6.
Ongoing clinical trials are now investigating the benefits of new targeted therapies, including ErbB and tyrosine kinase inhibitors (TKI) and antiangiogenics. Those may carry a potential risk for additional cardiac toxicity, particularly in association with radiotherapy. Although the risk of symptomatic cardiotoxicity is low, more subtle functional declines may increase mortality with longer follow-up and necessitate caution when assessing concurrent or sequential trastuzumab or lapatinib with radiotherapy. Potential additive toxicity encourages more conformal irradiation modalities minimizing cardiac dose, such as gating, intensity-modulated radiotherapy or Helical Tomotherapy. We recommend the collection of substantial information relevant to cardiac radiotoxicity in further clinical trials of targeted agents in breast cancer treatment, including doses delivered to cardiac structures, especially the coronary arteries. The incorporation of new biomarkers or modalities for assessment of cardiac function may also become necessary to detect cardiac toxicity at earliest stage.
目前正在进行临床试验，以研究新的靶向治疗的益处，包括 ErbB 和酪氨酸激酶抑制剂 (TKI) 和血管生成抑制剂。这些可能会带来额外的心脏毒性的潜在风险，特别是与放射治疗联合使用时。尽管症状性心脏毒性的风险较低，但随着随访时间的延长，更微妙的功能下降可能会增加死亡率，因此在评估曲妥珠单抗或拉帕替尼与放射治疗同时或序贯使用时需要谨慎。潜在的附加毒性鼓励采用更符合心脏剂量的照射方式，如门控、调强放疗或螺旋断层放疗。我们建议在乳腺癌治疗的靶向药物临床试验中收集与心脏放射性毒性相关的大量信息，包括心脏结构（特别是冠状动脉）的照射剂量。为了尽早发现心脏毒性，也可能需要采用新的生物标志物或心脏功能评估方式。
