Center for Precision Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO.
The University of Texas, MD Anderson Cancer Center, Houston, TX.
Semin Oncol. 2019 Dec;46(6):397-402. doi: 10.1053/j.seminoncol.2019.10.006. Epub 2019 Nov 11.
The opening session of Second International Colloquium on Cardio-Oncology addressed two areas of vital interest. The first reviewed new thoughts related to established agents. While anthracycline cardiotoxicity has been studied and reviewed extensively, ongoing research attempting to understand why it appears the mechanism(s) of toxicity differs from that of oncologic efficacy continue to evoke comment and intriguing speculation. Better understanding of the role of β-topoisomerase II in toxicity has advanced our understanding of the cascade of events that lead to heart failure. Additionally, the cardioprotective role of dexrazoxane fits well with our new understanding of how β-topoisomerase II works. Beyond the anthracyclines, new insight is providing us insight to better understand the impact on cardiac function seen with other agents including those targeting HER2 and several tyrosine-kinase inhibitors. Unlike the anthracyclines, these agents affect cardiac function in ways that are less direct, and therefore have different characteristics and should be thought of in alternate ways. This new knowledge regarding established agents furthers our understanding of the spectrum of cardiotoxicity and cardiac dysfunction in the cancer patient. The session also addressed cardiovascular toxicities of newer and established agents beyond myocardial dysfunction including effects on the vasculature. These agents cause changes that may be temporary or permanent, and that range from subclinical to life-threatening. The session ended with a discussion of the cardiac effects of immune checkpoint inhibitors. These agents can cause rare and sometimes fatal cardiac inflammation, for which long-term follow up may be required.
第二届心血管肿瘤学国际研讨会的开幕式重点讨论了两个至关重要的领域。第一个领域回顾了与现有药物相关的新观点。虽然蒽环类药物的心脏毒性已经得到了广泛的研究和综述，但目前仍在进行的研究试图了解为什么其毒性机制与肿瘤疗效的机制不同，这仍然引起了人们的关注和有趣的推测。更好地理解β-拓扑异构酶 II 在毒性中的作用，促进了我们对导致心力衰竭的一系列事件的理解。此外，右雷佐生的心脏保护作用与我们对β-拓扑异构酶 II 工作方式的新认识相吻合。除了蒽环类药物之外，新的见解还使我们能够更好地了解包括针对 HER2 和几种酪氨酸激酶抑制剂在内的其他药物对心脏功能的影响。与蒽环类药物不同，这些药物对心脏功能的影响不那么直接，因此具有不同的特征，应该以不同的方式来考虑。关于现有药物的这些新知识进一步加深了我们对癌症患者中心肌毒性和心脏功能障碍的认识。该会议还讨论了除心肌功能障碍以外的新型和现有药物的心血管毒性，包括对血管的影响。这些药物会引起暂时或永久性的变化，从亚临床到危及生命不等。会议以讨论免疫检查点抑制剂的心脏效应结束。这些药物可能会导致罕见且有时致命的心脏炎症，可能需要长期随访。
