Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Trends Cardiovasc Med. 2020 Jan;30(1):22-28. doi: 10.1016/j.tcm.2019.01.006. Epub 2019 Jan 29.
Breast cancer is the most common malignancy affecting females, with over 260,000 new cases annually and over 3.1 million survivors in the United States alone. Exposure to potentially cardiotoxic therapies, including anthracyclines, trastuzumab, and radiation therapy, coupled with host factors, place patients at increased risk for the development of cardiovascular disease (CVD) compared to non-cancer controls. Overall survival outcomes are significantly worse in patients who develop CVD, and in certain breast cancer populations, cardiovascular death exceeds the risk of cancer death in the long-term. In order to mitigate the risk of CVD, there is a growing interest in the use of cardioprotective strategies at the time of cancer therapy initiation. In this review, we present a detailed evaluation of the evidence from recently completed as well as ongoing cardio-oncology clinical trials in pharmacologic cardioprotection in breast cancer patients. We focus primarily on the potential role of dexrazoxane, alterations in anthracycline dosing or formulation, neurohormonal antagonists, beta-blockers, and combination therapy. We also discuss ongoing studies in statin cardioprotection, radiation delivery strategies, use of risk-guided strategies and the study of specific cancer populations. We close with a discussion of the ongoing needs in the field of cardio-oncology in order to advance the clinical care of patients with rigorous, evidence-based medicine.
乳腺癌是影响女性的最常见恶性肿瘤，仅在美国每年就有超过 26 万例新发病例和超过 310 万例幸存者。与非癌症对照相比，接触潜在的心脏毒性治疗方法，包括蒽环类药物、曲妥珠单抗和放射治疗，加上宿主因素，使患者发生心血管疾病（CVD）的风险增加。发生 CVD 的患者的总体生存结果明显更差，在某些乳腺癌人群中，长期来看心血管死亡超过癌症死亡的风险。为了降低 CVD 的风险，人们越来越关注在癌症治疗开始时使用心脏保护策略。在这篇综述中，我们详细评估了最近完成的以及正在进行的乳腺癌患者药物心脏保护作用的肿瘤心脏病学临床试验的证据。我们主要关注地塞米松、蒽环类药物剂量或制剂改变、神经激素拮抗剂、β受体阻滞剂和联合治疗的潜在作用。我们还讨论了他汀类药物心脏保护作用、放射治疗策略、风险指导策略的使用以及特定癌症人群的研究。最后，我们讨论了肿瘤心脏病学领域的持续需求，以便为具有严格循证医学的患者提供临床护理。
