Omland Torbjørn, Heck Siri Lagethon, Gulati Geeta
Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
JACC CardioOncol. 2022 Mar 15;4(1):19-37. doi: 10.1016/j.jaccao.2022.01.101. eCollection 2022 Mar.
Cardiotoxicity is a relatively frequent and potentially serious side effect of traditional and targeted cancer therapies. Both general measures and specific pharmacologic cardioprotective interventions as well as imaging- and biomarker-based surveillance strategies to identify patients at high risk have been tested in randomized controlled trials to prevent or attenuate cancer therapy-related cardiotoxic effects. Although meta-analyses including early trials suggest an overall beneficial effect, there is substantial heterogeneity in results. Recent randomized controlled trials of neurohormonal inhibitors in patients receiving anthracyclines and/or human epidermal growth factor receptor 2-targeted therapies have shown a lower rate of cancer therapy-related cardiac dysfunction than previously reported and a modest or no sustained effect of the interventions. Data on preventive cardioprotective strategies for novel cancer drugs are lacking. Larger, prospective multicenter randomized clinical trials testing traditional and novel interventions are required to more accurately define the benefit of different cardioprotective strategies and to refine risk prediction and identify patients who are likely to benefit.
心脏毒性是传统癌症疗法和靶向癌症疗法相对常见且可能严重的副作用。在随机对照试验中，已经对一般措施、特定的心脏保护药物干预措施以及基于成像和生物标志物的监测策略进行了测试，以识别高危患者，预防或减轻癌症治疗相关的心脏毒性作用。尽管包括早期试验在内的荟萃分析表明总体有益，但结果存在很大异质性。最近在接受蒽环类药物和/或人表皮生长因子受体2靶向治疗的患者中进行的神经激素抑制剂随机对照试验显示，与癌症治疗相关的心脏功能障碍发生率低于先前报道，且干预措施的效果适度或无持续作用。缺乏关于新型癌症药物预防性心脏保护策略的数据。需要进行更大规模的前瞻性多中心随机临床试验，以测试传统和新型干预措施，从而更准确地界定不同心脏保护策略的益处，并完善风险预测，识别可能受益的患者。
