Kamphuis Janine A M, Linschoten Marijke, Cramer Maarten J, Gort Eelke H, van Rhenen Anna, Asselbergs Folkert W, Doevendans Pieter A, Teske Arco J
Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
JACC CardioOncol. 2019 Dec 17;1(2):280-290. doi: 10.1016/j.jaccao.2019.09.007. eCollection 2019 Dec.
Cancer therapy-related cardiac dysfunction (CTRCD) is one of the most concerning cardiovascular side effects of cancer treatment. Important reviews within the field of cardio-oncology have described various agents to be associated with a high risk of CTRCD, including mitomycin C, ifosfamide, vincristine, cyclophosphamide, and clofarabine. The aim of this study was to provide insight into the data on which these incidence rates are based. We observed that the reported cardiotoxicity of mitomycin C and ifosfamide is based on studies in which most patients received anthracyclines, complicating the interpretation of their association with CTRCD. The high incidence of vincristine-induced cardiotoxicity is based on an incorrect interpretation of a single study. Incidence rates of clofarabine remain uncertain due to a lack of cardiac screening in clinical trials. The administration of high-dose cyclophosphamide (>1.5 g/m/day) is associated with a high incidence of CTRCD. Based on our findings, a critical re-evaluation of the cardiotoxicity of these agents is warranted.
癌症治疗相关的心脏功能障碍（CTRCD）是癌症治疗中最令人担忧的心血管副作用之一。心脏肿瘤学领域的重要综述描述了多种与CTRCD高风险相关的药物，包括丝裂霉素C、异环磷酰胺、长春新碱、环磷酰胺和氯法拉滨。本研究的目的是深入了解这些发病率所依据的数据。我们观察到，所报道的丝裂霉素C和异环磷酰胺的心脏毒性是基于大多数患者接受蒽环类药物治疗的研究，这使得对它们与CTRCD关联的解释变得复杂。长春新碱诱导的心脏毒性高发病率是基于对一项单一研究的错误解读。由于临床试验中缺乏心脏筛查，氯法拉滨的发病率仍不确定。高剂量环磷酰胺（>1.5 g/m²/天）的使用与CTRCD的高发病率相关。基于我们的研究结果，有必要对这些药物的心脏毒性进行批判性重新评估。
