Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK.
University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
Curr Cardiol Rep. 2021 Jan 26;23(3):16. doi: 10.1007/s11886-021-01446-x.
Cardiotoxicity can occur acutely during breast cancer treatment and impact the potential for the intended cancer treatment regime to be completed, or as a late effect affecting cancer survivorship. Indeed, the most common cause of mortality in females with early breast cancer is cardiovascular disease, especially in those over the age of 65. Optimal cancer care therefore needs to be delivered without jeopardising cardiovascular health. Understanding the different cardiotoxicities associated with breast cancer treatment is vital to this approach, and therefore, this article seeks to provide an overview of this.
Tyrosine kinase inhibitors targeting human epidermal growth factor receptor (HER)-2, immune checkpoint inhibitors (ICI), and cyclin-dependent kinase (CDK) inhibitors are new targeted breast cancer treatments. In particular, ICI are associated with myocarditis that carries a significant mortality, whilst the CDK inhibitor ribociclib causes QT prolongation that requires cardiac surveillance and appropriate dose adjustment to prevent ventricular arrhythmias. The need has always been for strategies to mitigate the risks of cardiovascular toxicities, and new data is promising for the use of dexrazoxane in anthracyclines, and the role of beta blockers and angiotensin converting enzymes inhibitors in anthracyclines and HER-2 monoclonal antibodies such as trastuzumab. Significant headways in breast cancer treatment have resulted in reductions in disease recurrence and mortality, but cardiovascular complications continue to impact the ability to deliver some of these cancer treatments, and the period of cancer survivorship.
乳腺癌治疗过程中可出现急性心脏毒性，从而影响既定癌症治疗方案的完成，或导致迟发性心脏毒性，影响癌症患者的生存。事实上，早期乳腺癌女性患者死亡的最常见原因是心血管疾病，尤其是年龄超过 65 岁的患者。因此，在不损害心血管健康的情况下，需要提供最佳的癌症治疗。了解乳腺癌治疗相关的不同心脏毒性对于采取这种方法至关重要，因此，本文旨在概述这一点。
针对人表皮生长因子受体（HER）-2 的酪氨酸激酶抑制剂、免疫检查点抑制剂（ICI）和细胞周期蛋白依赖性激酶（CDK）抑制剂是新的靶向乳腺癌治疗方法。特别是，ICI 与心肌炎有关，心肌炎具有显著的死亡率，而 CDK 抑制剂瑞博西利会导致 QT 间期延长，需要心脏监测和适当的剂量调整以预防室性心律失常。一直以来，人们都需要采取策略来降低心血管毒性的风险，新的数据表明，在蒽环类药物中使用右雷佐生、β受体阻滞剂和血管紧张素转换酶抑制剂在蒽环类药物和曲妥珠单抗等 HER-2 单克隆抗体中具有应用前景。乳腺癌治疗取得了显著进展，降低了疾病复发和死亡率，但心血管并发症继续影响一些癌症治疗的实施，以及癌症患者的生存。
