Suppr超能文献

心脏肿瘤学试验实施中的挑战:从研究他汀类药物预防蒽环类药物心脏毒性中汲取的经验教训。

Challenges in the implementation of cardio-oncology trials: lessons learnt from investigating statins in the prevention of anthracycline cardiotoxicity.

作者信息

Lee John, Tan Sean, Ramkumar Satish

机构信息

Victorian Heart Institute, Monash University, Melbourne, VIC, Australia.

Victorian Heart Hospital, Monash Health, 631 Blackburn Road Clayton VIC, Melbourne, VIC, 3168, Australia.

出版信息

Cardiooncology. 2024 Dec 18;10(1):88. doi: 10.1186/s40959-024-00292-4.

Abstract

Despite advanced in targeted cancer therapies, anthracyclines remain essential in treating various malignancies, albeit with risks of cancer therapy-related cardiac dysfunction (CTRCD). Out of the myriad of mitigation strategies for CTRCD, statins are an attractive preventive therapy for anthracycline associated CTRCD given their widespread availability, cheap costs and added benefit of atherosclerotic cardiovascular disease (ASCVD) risk reduction. Recent trials of PREVENT, SPARE-HF, and STOP-CA investigated atorvastatin's efficacy in preventing CTRCD, with mixed outcomes. While STOP-CA showed a significant reduction in CTRCD rates (22% vs. 8% in placebo), PREVENT and SPARE-HF found no statistical differences between statin and placebo groups. The trials faced challenges such as selection bias, exclusion of patients with comorbidities, and reliance on imaging-derived outcomes, which may not reflect clinically meaningful benefits. This calls for improved trial designs that prioritize diverse patient recruitment, longer follow-ups, and clinically relevant endpoints to enhance the translational impact of findings. Addressing these challenges collaboratively between oncology and cardiology will be crucial for optimizing patient outcomes in this vulnerable population. Future studies should emphasize both immediate cardioprotective effects and long-term cardiovascular benefits of statins, especially in the context of atherosclerotic cardiovascular disease in cancer survivors.

摘要

尽管靶向癌症治疗取得了进展,但蒽环类药物在治疗各种恶性肿瘤方面仍然至关重要,尽管存在癌症治疗相关心脏功能障碍(CTRCD)的风险。在众多针对CTRCD的缓解策略中,他汀类药物是一种有吸引力的预防蒽环类药物相关CTRCD的疗法,因为它们广泛可得、成本低廉,并且具有降低动脉粥样硬化性心血管疾病(ASCVD)风险的额外益处。最近的PREVENT、SPARE-HF和STOP-CA试验研究了阿托伐他汀预防CTRCD的疗效,结果不一。虽然STOP-CA显示CTRCD发生率显著降低(安慰剂组为22%,他汀组为8%),但PREVENT和SPARE-HF发现他汀组和安慰剂组之间没有统计学差异。这些试验面临着诸如选择偏倚、排除合并症患者以及依赖影像学衍生结果等挑战,而这些结果可能无法反映临床上有意义的益处。这就需要改进试验设计,优先考虑招募多样化的患者、进行更长时间的随访以及设定与临床相关的终点,以增强研究结果的转化影响力。肿瘤学和心脏病学之间合作应对这些挑战对于优化这一脆弱人群的患者预后至关重要。未来的研究应强调他汀类药物的即时心脏保护作用和长期心血管益处,尤其是在癌症幸存者的动脉粥样硬化性心血管疾病背景下。

相似文献

2
Statins to prevent early cardiac dysfunction in cancer patients at increased cardiotoxicity risk receiving anthracyclines.
Eur Heart J Cardiovasc Pharmacother. 2023 Sep 20;9(6):515-525. doi: 10.1093/ehjcvp/pvad031.
4
Statins for the Primary Prevention of Anthracycline Cardiotoxicity: A Comprehensive Review.
Curr Oncol Rep. 2024 Oct;26(10):1197-1204. doi: 10.1007/s11912-024-01579-6. Epub 2024 Jul 13.
5
Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials.
Int J Cardiol. 2023 Nov 15;391:131219. doi: 10.1016/j.ijcard.2023.131219. Epub 2023 Jul 30.
7
Role of Statin Therapy in Prevention of Anthracycline-Induced Cardiotoxicity: A Three Dimentional Echocardiography Study.
Curr Probl Cardiol. 2024 Jan;49(1 Pt C):102130. doi: 10.1016/j.cpcardiol.2023.102130. Epub 2023 Oct 18.
9
Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction.
J Am Heart Assoc. 2020 Jan 21;9(2):e014708. doi: 10.1161/JAHA.119.014708.

本文引用的文献

4
Statins as preventive therapy for anthracycline cardiotoxicity: a meta-analysis of randomized controlled trials.
Int J Cardiol. 2023 Nov 15;391:131219. doi: 10.1016/j.ijcard.2023.131219. Epub 2023 Jul 30.
5
Cardioprotection in Patients at High Risk of Anthracycline-Induced Cardiotoxicity: Primer.
JACC CardioOncol. 2023 Jun 20;5(3):292-297. doi: 10.1016/j.jaccao.2023.05.004. eCollection 2023 Jun.
6
Statins to prevent early cardiac dysfunction in cancer patients at increased cardiotoxicity risk receiving anthracyclines.
Eur Heart J Cardiovasc Pharmacother. 2023 Sep 20;9(6):515-525. doi: 10.1093/ehjcvp/pvad031.
7
Statins and Left Ventricular Ejection Fraction Following Doxorubicin Treatment.
NEJM Evid. 2022 Sep;1(9). doi: 10.1056/evidoa2200097. Epub 2022 Aug 18.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验