Cancer Chemother Pharmacol. 2013 Dec;72(6):1157-68. doi: 10.1007/s00280-013-2260-4.
Although most chemotherapeutic drugs have the potential to exert cardiotoxicity, these drugs have been chosen for use in cancer treatment because survival and curability benefits outweigh the risk of these complications. Anthracyclines, for example, are a powerful class of chemotherapeutic agents; however, their use is restricted by dose-related cardiotoxicity. Experimental evidence strongly supports the role of reactive oxygen species in this process, suggesting that antioxidants may be effective in protecting the heart from toxicity. Clinical use of antioxidants to protect the heart during anthracycline chemotherapy has been controversial due to the potential for reduced cytotoxic efficacy toward cancer cells. Results from randomized clinical trials addressing whether antioxidants either reduce the incidence of clinical heart failure among patients undergoing anthracycline-based chemotherapy or reduce the response rates to anthracycline-based chemotherapy have been unclear. While anthracyclines are by far the most well-studied antitumor agents with cardiotoxic properties, evidence now shows that reactive oxygen species may play roles in cardiotoxicity induced by other chemotherapeutic agents such as cyclophosphamide, cisplatin, 5-fluorouracil, and trastuzumab. Thus, in the new era of combination therapy and long-term survival of cancer patients, the use of antioxidants to support cancer therapy should be revisited.
虽然大多数化疗药物都有可能产生心脏毒性，但这些药物之所以被选择用于癌症治疗，是因为它们的生存和治愈益处大于这些并发症的风险。例如，蒽环类药物是一类强效的化疗药物；然而，由于其剂量相关的心脏毒性，其使用受到限制。实验证据强烈支持活性氧在这一过程中的作用，这表明抗氧化剂可能有助于保护心脏免受毒性。由于抗氧化剂可能降低对癌细胞的细胞毒性作用，因此在蒽环类化疗中使用抗氧化剂来保护心脏一直存在争议。关于抗氧化剂是否能降低接受蒽环类化疗的患者临床心力衰竭的发生率，或者降低蒽环类化疗的反应率的随机临床试验结果尚不清楚。虽然蒽环类药物是迄今为止研究最充分的具有心脏毒性的抗肿瘤药物，但现在有证据表明，活性氧可能在其他化疗药物（如环磷酰胺、顺铂、5-氟尿嘧啶和曲妥珠单抗）引起的心脏毒性中发挥作用。因此，在联合治疗和癌症患者长期生存的新时代，应该重新考虑使用抗氧化剂来支持癌症治疗。
