Anthracycline Cardiotoxicity in Adult Cancer Patients

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology Pub Date : 2024-10-01 DOI:10.1016/j.jaccao.2024.07.016

Massimiliano Camilli MD , Carlo Maria Cipolla MD , Susan Dent MD, BSc , Giorgio Minotti MD, PhD , Daniela Maria Cardinale MD, PhD

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Abstract

Since their introduction in the 1960s, anthracyclines have been a significant breakthrough in oncology, introducing dramatic changes in the treatment of solid and hematologic malignancies. Although new-generation targeted drugs and cellular therapies are revolutionizing contemporary oncology, anthracyclines remain the cornerstone of treatment for lymphomas, acute leukemias, and soft tissue sarcomas. However, their clinical application is limited by a dose-dependent cardiotoxicity that can reduce cardiac performance and eventually lead to overt heart failure. The field of cardio-oncology has emerged to safeguard the cardiovascular health of cancer patients receiving these therapies. It focuses on controlling risk factors, implementing preventive strategies, ensuring appropriate surveillance, and managing complications. This state-of-the-art review summarizes the current indications for anthracyclines in modern oncology, explores recent evidence on pathophysiology and epidemiology, and discusses advances in cardioprotection measures in the anthracycline-treated patient. Additionally, it highlights key clinical challenges and research gaps in this area.

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成人癌症患者的蒽环类药物心脏毒性

自 20 世纪 60 年代问世以来，蒽环类药物在肿瘤学领域取得了重大突破，为实体瘤和血液系统恶性肿瘤的治疗带来了巨大变化。虽然新一代靶向药物和细胞疗法正在彻底改变当代肿瘤学，但蒽环类药物仍然是治疗淋巴瘤、急性白血病和软组织肉瘤的基石。然而，蒽环类药物的临床应用受到剂量依赖性心脏毒性的限制，这种毒性会降低心脏功能，最终导致明显的心力衰竭。为了保护接受这些疗法的癌症患者的心血管健康，肿瘤心脏病学领域应运而生。其重点是控制风险因素、实施预防策略、确保适当的监测以及控制并发症。这篇最新综述总结了蒽环类药物在现代肿瘤学中的适应症，探讨了病理生理学和流行病学方面的最新证据，并讨论了蒽环类药物治疗患者心血管保护措施的进展。此外，它还强调了这一领域的主要临床挑战和研究空白。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Jacc: Cardiooncology Multiple-

CiteScore

12.50

自引率

6.30%

发文量

106

期刊介绍： JACC: CardioOncology is a specialized journal that belongs to the esteemed Journal of the American College of Cardiology (JACC) family. Its purpose is to enhance cardiovascular care for cancer patients by publishing high-quality, innovative scientific research and sharing evidence-based knowledge. The journal aims to revolutionize the field of cardio-oncology and actively involve and educate professionals in both cardiovascular and oncology fields. It covers a wide range of topics including pre-clinical, translational, and clinical research, as well as best practices in cardio-oncology. Key areas of focus include understanding disease mechanisms, utilizing in vitro and in vivo models, exploring novel and traditional therapeutics (across Phase I-IV trials), studying epidemiology, employing precision medicine, and investigating primary and secondary prevention. Amyloidosis, cardiovascular risk factors, heart failure, and vascular disease are some examples of the disease states that are of particular interest to the journal. However, it welcomes research on other relevant conditions as well.