Liu Liang, Liu Zhao-zhe, Liu Yong-ye, Zheng Zhen-dong, Liang Xue-feng, Han Ya-ling, Xie Xiao-dong
Department of Oncology, Cancer Center of General Hospital of Shenyang Military Command, Shenyang 110840, China.
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Zhonghua Zhong Liu Za Zhi. 2013 Dec;35(12):936-40.
To investigate the effect of low-dose carvedilol combined with candesartan in the prevention of acute and chronic cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.
Forty patients were randomly divided into two groups: the experimental group with chemotherapy plus low-dose carvedilol combined with candesartan (20 cases) and control group with chemotherapy alone (20 cases). The same chemotherapy was given to the two groups. All the 40 patients had no contraindication for carvedilol and candesartan. Patients of the experimental group received low-dose carvedilol from 2.5 mg orally twice a day at first cycle to 5 mg twice a day gradually if no side reactions, and candesartan 2.5 mg orally once a day. Electrocardiogram, ultrasonic cardiogram, arrhythmia, troponin and non-hematologic toxicity were recorded and compared after the second, forth and sixth cycle of chemotherapy. Each cycle included 21 days.
LVEF was decreased along with the prolongation of chemotherapy in the experimental group and control group. LVEDD and LVESD showed no significant changes in the experimental group, but gradually increased in the control group. After four and six cycles of chemotherapy, LVEF were (57.00 ± 5.13)% and (45.95 ± 3.68)%, respectively, in the control group, significantly lower than that of (67.00 ± 5.13)% and (57.50 ± 2.57)%, respectively, in the experimental group (P < 0.05). After six cycles of chemotherapy, LVEDD and LVESD were (50.00 ± 10.48) mm and (35.01 ± 2.99) mm, respectively, in the control group, significantly higher than those before chemotherapy (P < 0.05) and experimental group (P < 0.001). The rate of ST segment and T wave abnormalities was 80.0% in the control group after six cycles of chemotherapy, significantly higher than that of 25.0% after four cycles of chemotherapy (P = 0.001) and 10.0% after two cycles of chemotherapy (P < 0.001). The reduction of QRS voltage, arrhythmia and abnormal troponin were 55.0%, 45.0% and 45.0%, respectively, in the control group, significantly higher than those in the experimental group (20.0%, P < 0.05), (10.0%, P = 0.010) and (10.0%, P < 0.05), respectively. The rate of abnormal expression of troponin was 45.0% in the control group, significantly higher than the 10.0% in the experimental group (P < 0.05).
The use of low-dose carvedilol combined with candesartan can reduce the acute and chronic cardiotoxicity of anthracycline drugs, and with tolerable toxicities. This may provide a new approach to prevent cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.
探讨小剂量卡维地洛联合坎地沙坦预防蒽环类药物在乳腺癌辅助化疗中急慢性心脏毒性的作用。
40例患者随机分为两组：实验组20例，采用化疗加小剂量卡维地洛联合坎地沙坦治疗；对照组20例，单纯化疗。两组给予相同的化疗方案。40例患者均无卡维地洛和坎地沙坦的禁忌证。实验组患者在第1周期开始口服小剂量卡维地洛2.5mg，每日2次，若无不良反应则逐渐增至5mg，每日2次，同时口服坎地沙坦2.5mg，每日1次。在化疗第2、4、6周期后记录并比较心电图、超声心动图、心律失常、肌钙蛋白及非血液学毒性。每个周期为21天。
实验组和对照组化疗过程中左室射血分数（LVEF）均随化疗疗程延长而降低。实验组左室舒张末期内径（LVEDD）和左室收缩末期内径（LVESD）无明显变化，而对照组逐渐增大。化疗4周期和6周期后，对照组LVEF分别为（57.00±5.13）%和（45.95±3.68）%，明显低于实验组的（67.00±5.13）%和（57.50±2.57）%（P<0.05）。化疗6周期后，对照组LVEDD和LVESD分别为（50.00±10.48）mm和（35.01±2.99）mm，明显高于化疗前（P<0.0
