AP-HP, Hôpital René Muret, Cardiologie, Policlinique médicale, Université Paris-13, Faculté de Médecine de Bobigny, 93270 Sevran, France.
Int J Cardiol. 2010 Sep 24;144(1):3-15. doi: 10.1016/j.ijcard.2010.03.003. Epub 2010 Apr 18.
The spectrum of cardiac side-effects of cancer chemotherapy has expanded with the development of combination, adjuvant and targeted chemotherapies. Their administration in multiple regimens has increased greatly, including in older patients and in patients with cardiovascular and/or coronary artery disease (CAD). Cardiac toxicity of anthracyclines involves oxidative stress and apoptosis. Early detection combines 2D-echocardiography and/or radionuclide angiography and recent methods such as tissue Doppler imaging, strain rate echocardiography and sampling of serial troponin and/or NT-proBNP levels. Dexrazoxane has proven effective in the prevention of dose-related toxicity in children and adults. High doses of the alkylating drugs cyclophosphamide and ifosfamide may result in a reversible heart failure and in life-threatening arrhythmias. Myocardial ischemia induced by the antimetabolites 5-fluorouracil and capecitabine impacts prognosis of patients with prior CAD. Severe arrhythmias may complicate administration of microtubule inhibitors. Targeted therapies with the antibody-based tyrosine kinases (TK) inhibitors trastuzumab and, to a lesser extent, alemtuzumab induce heart failure or asymptomatic LV dysfunction in 1-4% and 10%, respectively. Cetuximab and rituximab induce hypotension, whereas bevacizumab may promote severe hypertension and venous thromboembolism. Small molecule TK inhibitors may also elicit LV dysfunction, in only few patients treated with imatinib mesylate, but in a substantially higher proportion of those receiving the multitargeted TK inhibitor sunitinib or the recently approved drugs erlotinib, lapatinib and dasatinib. Management of patients at increased cardiovascular risk associated with advancing age, previous CAD or targeted therapies may be optimized by referral to a cardiologist in a cross-specialty teamwork.
癌症化疗的心脏副作用谱随着联合、辅助和靶向化疗的发展而扩大。它们在多种方案中的应用大大增加，包括在老年患者和心血管疾病和/或冠状动脉疾病（CAD）患者中。蒽环类药物的心脏毒性涉及氧化应激和细胞凋亡。早期检测包括二维超声心动图和/或放射性核素血管造影，以及最近的方法，如组织多普勒成像、应变率超声心动图和连续肌钙蛋白和/或 NT-proBNP 水平的采样。地塞米松已被证明在预防儿童和成人剂量相关毒性方面有效。高剂量的烷化剂环磷酰胺和异环磷酰胺可能导致可逆性心力衰竭和危及生命的心律失常。抗代谢物 5-氟尿嘧啶和卡培他滨引起的心肌缺血影响先前患有 CAD 的患者的预后。严重的心律失常可能使微管抑制剂的给药复杂化。基于抗体的酪氨酸激酶（TK）抑制剂曲妥珠单抗和在较小程度上的阿仑单抗的靶向治疗分别在 1-4%和 10%的患者中诱导心力衰竭或无症状左心室功能障碍。西妥昔单抗和利妥昔单抗引起低血压，而贝伐单抗可能导致严重高血压和静脉血栓栓塞。小分子 TK 抑制剂也可能引起左心室功能障碍，仅在少数接受甲磺酸伊马替尼治疗的患者中，但在接受多靶点 TK 抑制剂舒尼替尼或最近批准的药物厄洛替尼、拉帕替尼和达沙替尼治疗的患者中比例更高。通过在跨专业团队中向心脏病专家转诊，可优化与年龄增长、先前 CAD 或靶向治疗相关的心血管风险增加的患者的管理。
