Wang Pei, Zhang Sheng, Zhang Xiao-bei, Li Wen-jin, Hao Xiao-meng, Zhang Jin
3rd Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Zhonghua Zhong Liu Za Zhi. 2013 Feb;35(2):135-9. doi: 10.3760/cma.j.issn.0253-3766.2013.02.013.
To evaluate the cardioprotective effects of dexrazoxane (DEX) on breast cancer patients who received anthracycline-containing chemotherapy.
A total of 122 breast cancer patients after operation were randomly divided into two groups: The experimental group of 61 cases treated with EPI plus DEX (DEX:EPI = 10:1) as adjuvant chemotherapy regimen, and the control group of 61 cases treated with EPI but without DEX. All patients received four cycles of adjuvant chemotherapy and their changes of specific cardiac functional status and hematology status before and after chemotherapy, as well as non-cardiac toxicity were observed and analyzed.
Brain natriuretic peptide (BNP) before chemotherapy and after four cycles of chemotherapy in the control group was (106.78 ± 4.52)×10(-6) µg/ml and (187.19 ± 8.71)×10(-6) µg/ml, respectively, with a significant difference between them (P < 0.05). It in the experimental group was (102.34 ± 8.76)×10(-6) µg/ml and (105.29 ± 7.21)×10(-6) µg/ml, respectively, without a significant difference (P > 0.05). Cardiac troponin T (cTnT) before chemotherapy and after four cycles of chemotherapy in the control group was (12.55 ± 2.73)×10(-3) µg/ml and ( 31.05 ± 7.10 )×10(-3) µg/ml, respectively, with a significant difference between them (P < 0.05). It in the experimental group was (12.70 ± 2.15)×10(-3) µg/ml and (13.65 ± 7.82)×10(-3) µg/ml, respectively, without a significant difference (P > 0.05). The hart rate (HR) before chemotherapy and after four cycles of chemotherapy in the control group, was 75.32 ± 7.14 bpm and 89.60 ± 9.21 bpm, respectively, with a significant difference (P < 0.05). It in the experimental group was 78.60 ± 6.29 bpm and 83.10 ± 7.56 bpm, respectively, without a significant difference (P > 0.05). The left ventricular ejection fraction (LVEF) before chemotherapy and after four cycles of chemotherapy in the control group was (65.23 ± 7.82)% and (55.21 ± 7.23)%, respectively, with a significant difference between them (P < 0.05). It in the experimental group was (64.12 ± 6.25)% and (59.6 ± 4.72)%, respectively, without a significant difference (P > 0.05). The absolute neutrophil count before chemotherapy and after four cycles of chemotherapy in the control group was (3.95 ± 1.36)×10(9)/L and (3.50 ± 1.52)×10(9)/L, respectively, without a significant difference (P > 0.05). It in the experimental group, was (4.96 ± 1.41)×10(9)/L and (3.10 ± 1.26)×10(9)/L, respectively, with a significant difference (P < 0.05). The incidence of grade I-IV bone marrow suppression in the experimental group was 21.3%, 16.4%, 24.6%, and 4.9%, respectively. It in the control group was 16.4%, 11.5%, 9.8%, and 5.5%, respectively, with a significant difference (P < 0.05).
Cardiac toxicity after anthracycline treatment in breast cancer patients may be significantly reduced by DEX, without increase of non-cardiac and and non-hematologic toxicity. DEX combined with anthracycline increases the risk of bone marrow suppression, therefore, peripheral blood picture should be monitored or routine bone marrow support may be needed.
评估右丙亚胺（DEX）对接受含蒽环类化疗的乳腺癌患者的心脏保护作用。
将122例乳腺癌术后患者随机分为两组：实验组61例，采用表柔比星加DEX（DEX:表柔比星=10:1）作为辅助化疗方案；对照组61例，仅采用表柔比星治疗，不使用DEX。所有患者均接受4个周期的辅助化疗，观察并分析化疗前后患者特定心功能状态、血液学状态的变化以及非心脏毒性。
对照组化疗前及4个周期化疗后的脑钠肽（BNP）分别为(106.78±4.52)×10(-6)μg/ml和(187.19±8.71)×10(-6)μg/ml，两者差异有统计学意义（P<0.05）。实验组化疗前及化疗后的BNP分别为(102.34±8.76)×10(-6)μg/ml和(105.29±7.21)×10(-6)μg/ml，差异无统计学意义（P>0.05）。对照组化疗前及4个周期化疗后的心肌肌钙蛋白T（cTnT）分别为(12.55±2.73)×10(-3)μg/ml和(31.05±7.10)×10(-3)μg/ml，两者差异有统计学意义（P<0.05）。实验组化疗前及化疗后的cTnT分别为(12.70±2.15)×10(-3)μg/ml和(13.65±7.82)×10(-3)μg/ml，差异无统计学意义（P>0.05）。对照组化疗前及4个周期化疗后的心率（HR）分别为75.32±7.14次/分和89.60±9.21次/分，差异有统计学意义（P<0.05）。实验组化疗前及化疗后的HR分别为78.60±6.29次/分和83.10±7.56次/分，差异无统计学意义（P>0.05）。对照组化疗前及4个周期化疗后的左心室射血分数（LVEF）分别为(65.23±7.82)%和(55.21±7.23)%，两者差异有统计学意义（P<0.05）。实验组化疗前及化疗后的LVEF分别为(64.12±6.25)%和(59.6±4.72)%，差异无统计学意义（P>0.05）；对照组化疗前及4个周期化疗后的绝对中性粒细胞计数分别为(3.95±1.36)×10(9)/L和(3.50±1.52)×10(9)/L，差异无统计学意义（P > 0.05）。实验组化疗前及化疗后的绝对中性粒细胞计数分别为(4.96±1.41)×10(9)/L和(3.10±1.26)×10(9)/L，差异有统计学意义（P<0.05）。实验组Ⅰ-Ⅳ度骨髓抑制发生率分别为21.3%、16.4%、24.6%和4.9%。对照组分别为16.4%、11.5%、9.8%和5.5%，差异有统计学意义（P<0.05）。
DEX可显著降低乳腺癌患者蒽环类治疗后的心脏毒性，且不增加非心脏及非血液学毒性。DEX联合蒽环类药物会增加骨髓抑制风险，因此，应监测外周血象或可能需要进行常规骨髓支持。
