Predicting and Preventing Anthracycline-Related Cardiotoxicity.
Predicting and Preventing Anthracycline-Related Cardiotoxicity.
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DOI：
10.1200/edbk_100015
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发表时间：
2018-05-23
期刊：
影响因子：
--
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
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作者：
Armenian, Saro;Bhatia, Smita
蒽环类药物(阿霉素、柔红霉素、表阿比星和伊达阿比星)是最有效的化疗药物之一，真正彻底改变了儿童癌症的治疗。它们构成了用于治疗儿童急性淋巴细胞性白血病、急性髓系白血病、霍奇金淋巴瘤、尤文肉瘤、骨肉瘤和神经母细胞瘤的化疗方案的骨干。超过50%的癌症儿童接受了蒽环类药物的治疗。蒽环类药物的临床效用受到剂量依赖性心脏毒性的影响，最初表现为无症状的心功能障碍，并不可逆转地演变为充血性心力衰竭。与普通人群相比，儿童癌症幸存者患充血性心力衰竭的风险增加了5到15倍。一旦诊断为充血性心力衰竭，5年存活率不到50%。已经为儿童癌症幸存者(即暴露于蒽环类药物之后)开发了预测模型，以确定那些心脏毒性风险增加的人。目前正在进行研究，以测试降低风险的策略。仍然有迫切的需要在确诊时(即，在暴露于蒽环类药物之前)识别儿童癌症患者，以便可以考虑非心脏毒性治疗。
Anthracyclines (doxorubicin, daunorubicin, epirubicin, and idarubicin) are among the most potent chemotherapeutic agents and have truly revolutionized the management of childhood cancer. They form the backbone of chemotherapy regimens used to treat childhood acute lymphoblastic leukemia, acute myeloid leukemia, Hodgkin lymphoma, Ewing sarcoma, osteosarcoma, and neuroblastoma. More than 50% of children with cancer are treated with anthracyclines. The clinical utility of anthracyclines is compromised by dose-dependent cardiotoxicity, manifesting initially as asymptomatic cardiac dysfunction and evolving irreversibly to congestive heart failure. Childhood cancer survivors are at a five- to 15-fold increased risk for congestive heart failure compared with the general population. Once diagnosed with congestive heart failure, the 5-year survival rate is less than 50%. Prediction models have been developed for childhood cancer survivors (i.e., after exposure to anthracyclines) to identify those at increased risk for cardiotoxicity. Studies are currently under way to test risk-reducing strategies. There remains a critical need to identify patients with childhood cancer at diagnosis (i.e., prior to anthracycline exposure) such that noncardiotoxic therapies can be contemplated.