Cardiovascular side effects of cancer therapies: a position statement from the Heart Failure Association of the European Society of Cardiology
Cardiovascular side effects of cancer therapies: a position statement from the Heart Failure Association of the European Society of Cardiology
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DOI：
10.1093/eurjhf/hfq213
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发表时间：
2011-01-01
影响因子：
18.2
通讯作者：
Shah, Ajay M.
中科院分区：
文献类型：
--
作者：
Eschenhagen, Thomas;Force, Thomas;Shah, Ajay M.
使用当前疗法在癌症患者中实现临床前死亡率和发病率的降低是一项重大成就。然而，鉴于其作用机制，许多抗癌药物可能具有显着的心血管副作用，包括诱发心力衰竭。这个问题的严重程度尚不清楚，而且从目前新兴靶向药物的临床试验中也不容易明显看出，这些药物通常不足以代表老年患者和患有严重合并症的患者。当经常调节生存途径的新药物相互组合或与其他常规细胞毒性化疗药物联合使用时，不良事件的风险也可能增加。肿瘤细胞（我们试图抑制）的生存和生长途径与心血管细胞（我们寻求保留）的生存和生长途径的一致程度是一个悬而未决的问题，但随着针对细胞内信号传导途径的新癌症疗法的开发，这个问题将变得越来越重要。目前尚不清楚是否可以通过分析此类基本信号机制来预测潜在的心血管问题以及应进行哪些临床前评估。患者的筛查、治疗方案的优化、治疗期间心血管功能的监测以及心血管副作用的管理可能对癌症患者变得越来越重要。本文总结了欧洲心脏病学会心力衰竭协会组织的跨学科研讨会（2009 年 5 月在布鲁塞尔举行）的讨论，该研讨会汇集了心脏病学和肿瘤学领域的临床医生以及基础科学、转化科学和制药科学领域的临床医生。
pre-clinicalreductions in mortality and morbidity being achieved among cancer patients with current therapies represent a major achievement. However, given their mechanisms of action, many anti-cancer agents may have significant potential for cardiovascular side effects, including the induction of heart failure. The magnitude of this problem remains unclear and is not readily apparent from current clinical trials of emerging targeted agents, which generally under-represent older patients and those with significant co-morbidities. The risk of adverse events may also increase when novel agents, which frequently modulate survival pathways, are used in combination with each other or with other conventional cytotoxic chemotherapeutics. The extent to which survival and growth pathways in the tumour cell (which we seek to inhibit) coincide with those in cardiovascular cells (which we seek to preserve) is an open question but one that will become ever more important with the development of new cancer therapies that target intracellular signalling pathways. It remains unclear whether potential cardiovascular problems can be predicted from analyses of such basic signalling mechanisms and what pre-clinical evaluation should be undertaken. The screening of patients, optimization of therapeutic schemes, monitoring of cardiovascular function during treatment, and the management of cardiovascular side effects are likely to become increasingly important in cancer patients. This paper summarizes the deliberations of a cross-disciplinary workshop organized by the Heart Failure Association of the European Society of Cardiology (held in Brussels in May 2009), which brought together clinicians working in cardiology and oncology and those involved in basic, translational, and pharmaceutical science.