Payne David L, Nohria Anju
Cardio-Oncology Program, Brigham and Women's Hospital/Dana Farber Cancer Institute, 75 Francis Street, Boston, MA, 02115, USA.
Curr Heart Fail Rep. 2017 Oct;14(5):398-403. doi: 10.1007/s11897-017-0353-9.
Cardiomyopathy is a significant complication of various cancer treatments and has been best studied in patients receiving anthracyclines and trastuzumab. This paper evaluates strategies to prevent chemotherapy-induced cardiotoxicity.
Increasing cumulative anthracycline dose, use of ≥2 cardiotoxic therapies, extremes of age, and pre-existing cardiovascular risk factors, or established cardiovascular disease, heighten the risk of developing chemotherapy-induced cardiomyopathy. Continuous rather than bolus anthracycline infusions, liposomal doxorubicin, or concomitant dexrazoxane reduces chemotherapy-induced cardiotoxicity. Treatment with neurohormonal antagonists or statins and exercise training during chemotherapy are promising, but as yet unproven, cardioprotective strategies. Identification of high-risk patients and optimization of their underlying cardiovascular risk factors/disease are essential to prevent cardiotoxicity. In patients requiring high-dose anthracyclines, continuous infusions, liposomal doxorubicin, or dexrazoxane should be considered to mitigate cardiotoxicity. Current data do not support the routine use of neurohormonal antagonists or statins as cardioprotective agents in patients treated with cardiotoxic chemotherapies.
心肌病是各种癌症治疗的一种重要并发症，在接受蒽环类药物和曲妥珠单抗治疗的患者中研究得最为充分。本文评估了预防化疗所致心脏毒性的策略。
累积蒽环类药物剂量增加、使用≥2种心脏毒性治疗方法、年龄极端情况、既往存在心血管危险因素或已确诊的心血管疾病，会增加发生化疗所致心肌病的风险。持续而非大剂量推注蒽环类药物、脂质体阿霉素或同时使用右丙亚胺可降低化疗所致心脏毒性。化疗期间使用神经激素拮抗剂或他汀类药物以及进行运动训练是有前景但尚未得到证实的心脏保护策略。识别高危患者并优化其潜在的心血管危险因素/疾病对于预防心脏毒性至关重要。在需要大剂量蒽环类药物的患者中，应考虑持续输注、脂质体阿霉素或右丙亚胺以减轻心脏毒性。目前的数据不支持在接受有心脏毒性化疗的患者中常规使用神经激素拮抗剂或他汀类药物作为心脏保护剂。
