Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, United States.
Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, VA, United States.
Adv Cancer Res. 2022;155:167-214. doi: 10.1016/bs.acr.2022.03.006. Epub 2022 Apr 20.
The quest of defeating cancer and improving prognosis in survivors has generated remarkable strides forward in research and have advanced the development of new antineoplastic therapies. These achievements, combined with rapid screening and early detection, have considerably extended the life expectancy of patients surviving multiple types of malignancies. Consequently, chemotherapy-related toxicity in several organ systems, especially the cardiovascular system, has surfaced as one of the leading causes of morbidity and mortality among cancer survivors. Recent evidence classifies chemotherapy-induced cardiotoxicity as the second-leading cause of morbidity and mortality, closely comparing with secondary cancer malignancies. While a certain degree of cardiotoxicity has been reported to accompany most chemotherapies, including anthracyclines, anti-metabolites, and alkylating agents, even the latest targeted cancer therapies such as immune checkpoint inhibitors and tyrosine kinase inhibitors have been associated with acute and chronic cardiac sequelae. In this chapter, we focus on describing the principal mechanism(s) for each class of chemotherapeutic agents that lead to cardiotoxicity and the innovative translational research approaches that are currently being explored to prevent or treat cancer therapy-induced cardiotoxicity and related cardiac complications.
战胜癌症和改善幸存者预后的探索在研究方面取得了显著进展，并推动了新型抗肿瘤疗法的发展。这些成就，加上快速筛查和早期检测，大大延长了多种恶性肿瘤幸存者的预期寿命。因此，化疗相关的毒性在多个器官系统中出现，尤其是心血管系统，已成为癌症幸存者发病率和死亡率的主要原因之一。最近的证据将化疗引起的心脏毒性归类为发病率和死亡率的第二大原因，与继发性癌症相当。虽然大多数化疗药物（包括蒽环类药物、抗代谢物和烷化剂）都有一定程度的心脏毒性，但即使是最新的靶向癌症疗法，如免疫检查点抑制剂和酪氨酸激酶抑制剂，也与急性和慢性心脏后遗症有关。在这一章中，我们专注于描述导致心脏毒性的每一类化疗药物的主要机制以及目前正在探索的创新转化研究方法，以预防或治疗癌症治疗引起的心脏毒性和相关心脏并发症。
