Department of Medicine, 12328Vanderbilt University Medical Center, Nashville, TN, USA.
J Cardiovasc Pharmacol Ther. 2021 Mar;26(2):103-113. doi: 10.1177/1074248420968689. Epub 2020 Oct 30.
Cardio-Oncology has blossomed as a new field in cardiovascular medicine, in large part due to new therapies, which may have cardiovascular sequelae. Despite this, anthracyclines still serve as cornerstone therapy for most pediatric cancers, several solid tumors and hematological malignancies. Cardiotoxicity is the main limiting concern with anthracyclines, and this is particularly an issue in patients in extremes of age (both young and old patients). Pediatric hearts are susceptible for cardiotoxicity, while in older patients, concomitant risk factors may contribute to lower threshold for cardiotoxic effects. With increasing patient survival, a significant increase in elderly cancer patients and long-term cardiotoxicity effects of anthracyclines, a better mechanistic understanding of age-dependent processes-that define cardiotoxicity-is needed. This review sheds light on how age affects underlying molecular pathways of anthracycline-associated cardiotoxicity and aims to provide preventive strategies that can be used in clinical practice.
心脏肿瘤学已成为心血管医学中的一个新兴领域，这在很大程度上要归功于新的治疗方法，这些方法可能会产生心血管后遗症。尽管如此，蒽环类药物仍然是大多数儿科癌症、几种实体瘤和血液恶性肿瘤的基石治疗方法。蒽环类药物的主要限制是心脏毒性，这在年龄极端的患者（年轻和老年患者）中尤为重要。儿科心脏易受心脏毒性影响，而在老年患者中，伴随的危险因素可能导致心脏毒性作用的阈值降低。随着患者生存率的提高，老年癌症患者数量显著增加，以及蒽环类药物的长期心脏毒性作用，需要更好地了解年龄相关过程的机制，这些过程定义了心脏毒性。本综述探讨了年龄如何影响蒽环类药物相关心脏毒性的潜在分子途径，并旨在提供可在临床实践中使用的预防策略。
