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超越蒽环类药物:血液系统恶性肿瘤靶向治疗时代心血管毒性的预防性管理

Beyond Anthracyclines: Preemptive Management of Cardiovascular Toxicity in the Era of Targeted Agents for Hematologic Malignancies.

作者信息

Sethi Tarsheen K, Basdag Basak, Bhatia Nirmanmoh, Moslehi Javid, Reddy Nishitha M

机构信息

Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 3927 The Vanderbilt Clinic, Nashville, TN, USA.

Division of Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

出版信息

Curr Hematol Malig Rep. 2017 Jun;12(3):257-267. doi: 10.1007/s11899-017-0369-y.

Abstract

Advances in drug discovery have led to the use of effective targeted agents in the treatment of hematologic malignancies. Drugs such as proteasome inhibitors in multiple myeloma and tyrosine kinase inhibitors in chronic myeloid leukemia and non-Hodgkin lymphoma have changed the face of treatment of hematologic malignancies. There are several reports of cardiovascular adverse events related to these newer agents. Both "on-target" and "off-target" effects of these agents can cause organ-specific toxicity. The need for long-term administration for most of these agents requires continued monitoring of toxicity. Moreover, the patient population is older, often over 50 years of age, making them more susceptible to cardiovascular side effects. Additional factors such as prior exposure to anthracyclines often add to this toxicity. In light of their success and widespread use, it is important to recognize and manage the unique side effect profile of targeted agents used in hematologic malignancies. In this article, we review the current data for the incidence of cardiovascular side effects of targeted agents in hematologic malignancies and discuss a preemptive approach towards managing these toxicities.

摘要

药物研发的进展促使有效的靶向药物被用于治疗血液系统恶性肿瘤。诸如用于多发性骨髓瘤的蛋白酶体抑制剂以及用于慢性髓性白血病和非霍奇金淋巴瘤的酪氨酸激酶抑制剂等药物,已经改变了血液系统恶性肿瘤的治疗面貌。有几份关于这些新型药物相关心血管不良事件的报告。这些药物 “靶向” 和 “非靶向” 效应均可导致器官特异性毒性。大多数此类药物需要长期给药,这就需要持续监测毒性。此外,患者群体年龄较大,通常超过50岁,这使得他们更容易出现心血管副作用。其他因素,如既往使用过蒽环类药物,往往会加重这种毒性。鉴于这些药物的成功和广泛应用,认识并处理血液系统恶性肿瘤中使用的靶向药物独特的副作用特征非常重要。在本文中,我们回顾了目前关于血液系统恶性肿瘤中靶向药物心血管副作用发生率的数据,并讨论了针对这些毒性的预先处理方法。

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