Departments of Oncology, Breast Center, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany.
Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, USA.
Ann Oncol. 2011 Jun;22(6):1250-1258. doi: 10.1093/annonc/mdq543. Epub 2010 Nov 26.
Adjuvant therapy has improved the survival of women with early breast cancer (BC). Meta-analyses suggest that anthracycline-based regimens reduced the annual BC death rate by ∼40% in women below the age of 50 and 20% in older women. Novel agents designed to modulate abnormal growth factor signaling in and around the BC cell further increase patients' chances of survival. However, both conventional chemotherapeutic agents as well as some of the novel signaling inhibitors can induce important cardiovascular side-effects, potentially attenuating the progress made in recent years. The mechanism of cancer drug-induced cardiovascular complications varies greatly with some compounds inducing irreversible myocardial cell damage, while others lead to temporary cell dysfunction. The challenge of the future will be to prospectively discriminate between irreversible damage which can lead to progressive cardiovascular disease and reversible cardiovascular dysfunctions without further prognostic implications. Since adjuvant therapy for BC is potentially curative, emphasis must be placed on finding treatments combining maximum efficacy with the minimum of long-term side-effects in order to achieve survival with preserved quality of life.
辅助治疗已经改善了早期乳腺癌（BC）女性的生存状况。荟萃分析表明，蒽环类药物方案降低了 50 岁以下女性每年的 BC 死亡率约 40%，老年女性降低了 20%。旨在调节 BC 细胞内外异常生长因子信号的新型药物进一步增加了患者的生存机会。然而，传统的化疗药物和一些新型信号抑制剂都可能导致重要的心血管副作用，可能会削弱近年来取得的进展。癌症药物引起的心血管并发症的机制差异很大，一些化合物会导致不可逆的心肌细胞损伤，而另一些则导致暂时性的细胞功能障碍。未来的挑战将是前瞻性地区分可能导致进行性心血管疾病的不可逆损伤和没有进一步预后意义的可逆性心血管功能障碍。由于 BC 的辅助治疗有潜在的治愈效果，因此必须找到将最大疗效与最小长期副作用相结合的治疗方法，以在保留生活质量的情况下实现生存。
