[雄激素剥夺疗法治疗激素依赖性前列腺癌的心血管风险：促性腺激素释放激素拮抗剂与促性腺激素释放激素激动剂之间的差异]

[Cardiovascular risk of androgen deprivation therapy for treatment of hormone-dependent prostate cancer : Differences between GnRH antagonists and GnRH agonists].

作者信息

Tschöpe C, Kherad B, Spillmann F, Schneider C A, Pieske B, Krackhardt F

机构信息

Abteilung für Kardiologie, Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK), Augustenburger Platz 1, 13353, Berlin, Deutschland.

Berliner Zentrum für Regenerative Therapien (BCRT), Campus Virchow-Klinikum (CVK), Berlin, Deutschland.

出版信息

Herz. 2016 Dec;41(8):697-705. doi: 10.1007/s00059-016-4422-8. Epub 2016 Apr 15.

DOI:10.1007/s00059-016-4422-8

Abstract

BACKGROUND

Several studies have indicated that reduction of testosterone levels in patients with prostate cancer undergoing androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists can be associated with an increased risk of cardiovascular events. The GnRH antagonists have a different mode of action compared with GnRH agonists and may be preferred in ADT for patients with cardiovascular disease.

OBJECTIVE

This review article discusses potential mechanisms underlying the development of cardiovascular events associated with ADT when using GnRH agonists and explains the differences in mode of action between GnRH agonists and GnRH antagonists. Additionally, relevant studies are presented and practical recommendations for the clinical practice are provided.

MATERIAL AND METHODS

A literature search was performed. Full publications and abstracts published in the last 10 years up to September 2015 were considered to be eligible.

RESULTS

The GnRH antagonists were associated with a decreased risk of cardiovascular events compared with GnRH agonists in prostate cancer patients undergoing ADT and particularly in patients with cardiovascular risk factors or a history of cardiovascular disease. This decrease may be due to the different mode of action of GnRH antagonists compared with GnRH agonists.

CONCLUSION

Prostate cancer patients with either cardiovascular disease or an increased risk of experiencing a cardiovascular event undergoing ADT should be preferentially treated with GnRH antagonists.

摘要

背景

多项研究表明，接受促性腺激素释放激素（GnRH）激动剂雄激素剥夺治疗（ADT）的前列腺癌患者，其睾酮水平降低可能与心血管事件风险增加有关。与GnRH激动剂相比，GnRH拮抗剂具有不同的作用方式，对于患有心血管疾病的患者，在ADT中可能更受青睐。

目的

这篇综述文章讨论了使用GnRH激动剂进行ADT时发生心血管事件的潜在机制，并解释了GnRH激动剂和GnRH拮抗剂作用方式的差异。此外，还介绍了相关研究并提供了临床实践的实用建议。

材料与方法

进行了文献检索。截至2015年9月的过去10年中发表的完整出版物和摘要被认为符合条件。

结果

在接受ADT的前列腺癌患者中，尤其是有心血管危险因素或心血管疾病史的患者，与GnRH激动剂相比，GnRH拮抗剂与心血管事件风险降低相关。这种降低可能是由于GnRH拮抗剂与GnRH激动剂作用方式不同所致。

结论

患有心血管疾病或接受ADT时发生心血管事件风险增加的前列腺癌患者，应优先使用GnRH拮抗剂进行治疗。