Kim Peter Y, Ewer Michael S
Department of Cardiology, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA.
Curr Treat Options Cardiovasc Med. 2014 May;16(5):303. doi: 10.1007/s11936-014-0303-8.
Cardiotoxic adverse events are of concern to physicians treating cancer patients; they are encountered with a variety of agents. Cardiac events may delay the approval of new drugs or impose burdensome monitoring requirements as either part of the pre-approval process or in the daily use of these agents. Among the cardiac issues are the development of QT prolongation and the fear of torsades de pointes (TdP), an unusual yet potentially fatal form of ventricular tachycardia associated with QT prolongation. Several risk factors, including electrolyte imbalance and polypharmacy with concomitant QT prolonging agents use can increase the risk of TdP in cancer patients; separating the individual contributions of the various triggers for TdP remains problematic. Understanding the individual risk of QT prolongation associated with particular chemotherapies can better differentiate between those shown to have higher risk vs. those with lower risk potential. Cardiac monitoring and electrocardiogram analysis require recognition of the common challenges with regard to the precise measurement of the QT interval such as the presence of U waves, intraventricular conduction delays, and heart rate correction. Rapid identification and treatment of QT prolongation and TdP is critical in mitigating the risk of sudden cardiac death in cancer patients. A multidisciplinary treatment approach among cardiologists and oncologists should be employed to help facilitate an appropriate balance between oncologic efficacy and adverse cardiac events.
心脏毒性不良事件是治疗癌症患者的医生所关注的问题；多种药物都会引发此类事件。心脏事件可能会延迟新药的获批，或者在新药获批前的过程中，以及在这些药物的日常使用中，带来繁重的监测要求。心脏问题包括QT间期延长的发生，以及对尖端扭转型室性心动过速（TdP）的担忧，TdP是一种与QT间期延长相关的不常见但可能致命的室性心动过速形式。包括电解质失衡和联合使用多种可延长QT间期的药物在内的几个风险因素，会增加癌症患者发生TdP的风险；区分导致TdP的各种诱因的个体作用仍然存在问题。了解与特定化疗相关的QT间期延长的个体风险，能够更好地区分那些显示出较高风险的患者与具有较低风险可能性的患者。心脏监测和心电图分析需要认识到在精确测量QT间期方面的常见挑战，如U波的存在、室内传导延迟和心率校正。快速识别和治疗QT间期延长及TdP对于降低癌症患者心脏性猝死的风险至关重要。心脏病专家和肿瘤学家应采用多学科治疗方法，以帮助在肿瘤疗效和不良心脏事件之间实现适当的平衡。
