前列腺癌激素治疗的心血管安全性

D. Andreev, A. Zavyalov
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摘要

背景。截至2019年,前列腺癌(PCa)是俄罗斯男性中第二常见的恶性肿瘤(占2019年发现的所有癌症病例的15.7%)。心血管疾病,特别是动脉粥样硬化,被认为是前列腺癌患者死亡的第二大常见原因。以促性腺激素释放激素(GnRH)激动剂和拮抗剂(leuprolide和degarelix)、第二代抗雄激素(enzalutamide)和类固醇生成抑制剂(abiraterone)为例,评估激素治疗前列腺癌的心血管安全性。材料和方法。我们分析了发表于2020-2021年并在PubMed检索的评估PCa患者激素治疗心血管安全性的原始研究结果。其他荟萃分析和系统评价的结果未被纳入。使用PubMed数据库和Google系统进行出版物搜索。检索关键词:前列腺癌、心血管风险、心血管安全性、结局、动脉粥样硬化等。我们分析了2020年1月至2022年1月之间发表的研究。英文和俄文的文章是手工选择的;没有使用过滤器。我们检查了最新和最相关的原始研究结果,评估了PCa关键创新激素治疗的心血管安全性。最近的大多数研究都是基于常规临床实践;他们都登记在高度专业化的癌症登记处。激素治疗与心脏毒性相关,这增加了前列腺癌患者非癌症相关死亡的风险。新的、有时相互矛盾的证据正在不断积累。这一证据表明,GnRH拮抗剂(degarelix)比GnRH激动剂(leuprolide)具有更好的心血管安全性;恩杂鲁胺比阿比特龙更安全。需要进一步寻找前列腺癌患者的预后生物标志物。在常规临床实践中进行更多高质量的研究,分析PCa患者的不良心血管事件,并在在线数据库中注册,是确定一种抗肿瘤药物优于另一种药物的下一个阶段。这将有助于为PCa患者选择最佳的激素治疗算法,从而提高他们的总生存率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cardiovascular safety of hormone therapy for prostate cancer
Background. As of 2019, prostate cancer (PCa) is the second most common malignancy in men living in Russia (15.7 % of all cancer cases detected in 2019). Cardiovascular diseases, in particular atherosclerosis, are believed to be the second most frequent cause of death in PCa patients.Aim. To evaluate cardiovascular safety of hormone therapy for PCa on the example of gonadotropin releasing hormone (GnRH) agonists and antagonists (leuprolide and degarelix), second-generation antiandrogens (enzalutamide), and steroidogenesis inhibitors (abiraterone).Materials and methods. We analyzed the results of original studies assessing cardiovascular safety of hormone therapy in PCa patients published in 2020–2021 and indexed in PubMed. The results of other meta-analyses and systematic reviews were not included.The search for publications was performed using the PubMed database and the Google system. The following key words were used for searching: prostate cancer, cardiovascular risks, cardiovascular safety, outcomes, atherosclerosis, etc. We analyzed studies published between January 2020 and January 2022. Articles in English and Russian were selected manually; no filters were applied.Results. We examined the results of the latest and most relevant original studies assessing cardiovascular safety of key innovative hormone therapies for PCa. The majority of recent studies were based on routine clinical practice; they were registered in highly specialized cancer registers.Hormone therapy is associated with cardiotoxicity, which increases the risk of non-cancer related death in PCa patients. New, sometimes conflicting evidence is being constantly accumulated. This evidence suggests that the GnRH antagonist (degarelix) has a better cardiovascular safety profile than the GnRH agonist (leuprolide); enzalutamide is safer than abiraterone. Further search for prognostic biomarkers in PCa patients is needed.Conclusion. More high-quality studies analyzing adverse cardiovascular events in PCa patients conducted in routine clinical practice and registered in the online databases are the next stage to identify benefits of one antitumor drug over another. This will help to choose optimal hormone therapy algorithms for PCa patients and, therefore, increase their overall survival.
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