Kundnani Nilima Rajpal, Passini Vincenzo, Stefania Carlogea Iulia, Dumitrescu Patrick, Meche Vlad, Buzas Roxana, Duda-Seiman Daniel Marius
University Clinic of Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, Department VI-Cardiology, "Victor Babes" University of Medicine and Pharmacy, 3000041 Timisoara, Romania.
Research Centre of Timisoara Institute of Cardiovascular Diseases, "Victor Babes" University of Medicine and Pharmacy, 3000041 Timisoara, Romania.
Medicina (Kaunas). 2025 Apr 12;61(4):709. doi: 10.3390/medicina61040709.
Cancer medications can cause cardiac issues, which are difficult to treat in oncologic patients because of the risk of complications. In some cases, this may significantly impact their well-being and treatment outcomes. Overall, these complications fall under the term "drug induced cardiotoxicity", mainly due to chemotherapy drugs being specifically toxic to the heart, causing a decrease in the heart's capacity to pump blood efficiently and leading to a reduction in the left ventricular ejection fraction (LVEF), and subsequently possibly leading to heart failure. Anthracyclines, alkylating agents, and targeted therapies for cancer hold the potential of causing harmful effects on the heart. The incidence of heart-related issues varies from patient to patient and depends on multiple factors, including the type of medication, dosage, duration of the treatment, and pre-existing heart conditions. The underlying mechanism leading to oncologic-drug-induced cardiovascular harmful effects is quite complex. One particular group of drugs, called anthracyclines, have garnered attention due to their impact on oxidative stress and their ability to cause direct harm to heart muscle cells. Reactive oxygen species (ROS) cause harm by inducing damage and programmed cell death in heart cells. Conventional biomarkers alone can only indicate some degree of damage that has already occurred and, therefore, early detection is key. Novel methods like genetic profiling are being developed to detect individuals at risk, prior to the onset of clinical symptoms. Key management strategies-including early detection, personalized medicine approaches, and the use of novel biomarkers-play a crucial role in mitigating cardiotoxicity and improving patient outcomes. Identification of generated genetic alterations and the association to an increased likelihood of cardiotoxicity will allow treatment in a more personalized approach, aiming at decreasing rates of cardiac events while maintaining high oncological efficacy. Oncology drug-induced cardiotoxicity is managed through a combination of preventive strategies and therapeutic interventions from the union of cardiac and oncological knowledge.
癌症药物可引发心脏问题，由于存在并发症风险，这些问题在肿瘤患者中难以治疗。在某些情况下，这可能会对他们的健康和治疗结果产生重大影响。总体而言，这些并发症属于“药物性心脏毒性”范畴，主要是因为化疗药物对心脏具有特异性毒性，导致心脏有效泵血能力下降，左心室射血分数（LVEF）降低，进而可能导致心力衰竭。蒽环类药物、烷化剂和癌症靶向治疗药物都有可能对心脏产生有害影响。心脏相关问题的发生率因患者而异，取决于多种因素，包括药物类型、剂量、治疗持续时间以及既往存在的心脏疾病。导致肿瘤药物引起心血管有害影响的潜在机制相当复杂。一类被称为蒽环类药物的特定药物，因其对氧化应激的影响以及对心肌细胞造成直接损害的能力而受到关注。活性氧（ROS）通过诱导心脏细胞损伤和程序性细胞死亡来造成损害。仅靠传统生物标志物只能表明已经发生的某种程度的损害，因此早期检测至关重要。正在开发基因谱分析等新方法，以便在临床症状出现之前检测出有风险的个体。关键管理策略——包括早期检测、个性化医疗方法以及新型生物标志物的使用——在减轻心脏毒性和改善患者治疗结果方面发挥着关键作用。识别产生的基因改变及其与心脏毒性增加可能性的关联，将有助于采用更个性化的治疗方法，目标是在保持高肿瘤疗效的同时降低心脏事件发生率。肿瘤药物引起的心脏毒性通过结合心脏和肿瘤学知识的预防策略和治疗干预措施来进行管理。
