Oncology Unit of the 3(rd) Internal Medicine Clinic, Sotiria General Hospital, Athens Medical School, Greece.
Oncology Unit of the 3(rd) Internal Medicine Clinic, Sotiria General Hospital, Athens Medical School, Greece.
Hellenic J Cardiol. 2018 Jul-Aug;59(4):196-200. doi: 10.1016/j.hjc.2018.01.013. Epub 2018 Mar 29.
Everolimus (EVE) is now approved by many agencies for the treatment of variable neoplasms. The risk for adverse events with this agent is not adequately defined. The purpose of this review is to summarize the EVE-induced cardiotoxic effect as an antineoplastic factor on patients who received the specific drug and to evaluate any possible antiatherogenic effects due to systemic use of the drug. Articles were searched on PubMed until August 2017. Articles included an expanded-access clinical trial, as well as phase 2 or 3 clinical trials (most of them were randomized). Three experimental studies that provided evidence for the possible antiatherogenic action of EVE were also included. In addition, only studies that evaluated the systemic use of the drug were included. To be eligible for inclusion, trials should have evaluated patients with malignancy, treated by EVE, or assessed the antiatherogenic effect of the systemic use of EVE through clinical or experimental studies. Only articles written in English language were included. No direct cardiotoxic adverse effects (arrhythmia, acute coronary event, heart failure, and echocardiography pathologic findings) were reported. Patients appeared to have a risk of developing adverse events that could be associated with the risk factors of cardiovascular disease. In all clinical studies, patients suffered hyperglycemia, and in most of them, hyperlipidemia was observed. Fewer studies have reported the incidence of hypertension. Finally, there is evidence claiming that EVE has an antiatherogenic action. Three experimental studies have shown that the systemic use of EVE in mice or rabbits with atherosclerotic lesions led to the reduction in atheromatous plaque growth. However, we could not find any clinical study that showed similar results in patients with cancer. To sum up, the only reported cardiac adverse event of EVE treatment in patients with cancer is indirect. They are associated with the risk factors of cardiovascular disease (hyperglycemia, hyperlipidemia, and hypertension), which are mainly mild and easily manageable. Further research and data that support the antiatherogenic action of EVE are needed.
依维莫司（EVE）现已获得多个机构批准，用于治疗多种肿瘤。但该药的不良反应风险尚未充分明确。本综述的目的是总结 EVE 作为一种抗肿瘤药物对接受该药物治疗的患者的心脏毒性作用，并评估该药物系统应用可能产生的抗动脉粥样硬化作用。检索了截至 2017 年 8 月的 PubMed 数据库中的文献。这些文献包括扩展使用临床试验，以及 2 期或 3 期临床试验（其中大多数为随机对照试验）。还纳入了 3 项提供 EVE 可能具有抗动脉粥样硬化作用的证据的实验研究。此外，仅纳入评估该药物系统应用的研究。纳入标准为评估了恶性肿瘤患者，采用 EVE 治疗，并通过临床或实验研究评估 EVE 系统应用的抗动脉粥样硬化作用的研究。仅纳入英语文献。未报告心律失常、急性冠脉事件、心力衰竭和超声心动图异常等直接心脏毒性不良反应。患者似乎有发生与心血管疾病相关的危险因素相关不良反应的风险。在所有临床研究中，患者均出现高血糖，其中大多数患者还观察到血脂异常。较少的研究报告了高血压的发生率。最后，有证据表明 EVE 具有抗动脉粥样硬化作用。3 项实验研究表明，在有动脉粥样硬化病变的小鼠或兔中系统应用 EVE 可减少动脉粥样斑块生长。然而，我们尚未找到任何在癌症患者中显示类似结果的临床研究。综上所述，目前仅报道了癌症患者应用 EVE 治疗的间接心脏不良事件，这些事件与心血管疾病的危险因素（高血糖、血脂异常和高血压）相关，且主要为轻度，易于处理。需要进一步研究和提供数据来支持 EVE 的抗动脉粥样硬化作用。
