心脏肿瘤学：心血管调查的新临床前沿和新颖的平台
Cardio-Oncology: A New Clinical Frontier and Novel Platform for Cardiovascular Investigation
影响因子:38.60000
分区:医学1区 Top / 心脏和心血管系统1区 外周血管病1区
发表日期:2024 Aug 13
作者:
Javid J Moslehi
摘要
在过去的20年中，心脏肿瘤学已成为一种新的心血管亚专科性。较旧的非特异性化学疗法（例如蒽环类药物）和辐射已很好地描述了心脏毒性剂，DRS最初在儿科种群中广泛研究了与蒽环类药物相关的心力衰竭。史蒂文·利普斯（Steven Lipshultz）（心脏病专家）和斯蒂芬·萨兰（Stephen Sallan）（肿瘤学家）。希望是，随着新型靶向疗法的出现，这些毒性将被削弱。然而，20多年前，很明显，暴露于trastuzumab的患者中，有针对性的乳腺癌治疗可能会患有心肌病，需要在治疗过程中基于成像的心脏监测。从那时起，从生物制剂到小分子抑制剂以及跨越不同类别的多种新型靶向癌症疗法与急性和慢性心血管和心脏代谢并发症有关。由于癌症患者的预后改善，慢性后遗症在临床上变得更加相关。在美国，有近20,000,000个癌症幸存者，占人口的6％。心血管疾病而不是癌症是该人群中死亡的主要原因。鉴于将不断扩展的肿瘤疗法引入实践中，心脏肿瘤学代表了一种新的临床领域。这些疗法与独特的临床心血管和心脏代谢综合征有关。例如，十年前，很少有人会预测来自免疫检查点抑制剂（ICI）的心血管并发症，即目前在50％的癌症患者中批准的免疫疗法。炎症性心肌病（包括心肌炎和心包炎）在实践中代表着重要的新急性临床挑战。 ICI的慢性心血管效应尚未定义。鉴于这些临床实体，诊断和治疗需要新的方法。
Abstract
In the past 20 years, cardio-oncology has emerged as a new cardiovascular subspeciality. Older, non-specific chemotherapies (such as anthracyclines) and radiation had been well-described cardiotoxic agents, with anthracycline-associated heart failure initially extensively studied in the pediatric population by Drs. Steven Lipshultz (a cardiologist) and Stephen Sallan (an oncologist). The hope was that with the emergence of novel targeted therapies, these toxicities would be curtailed. However, more than 20 years ago, it became apparent that a percentage of patients exposed to trastuzumab, a targeted breast cancer therapy, can suffer from cardiomyopathy, necessitating imaging-based cardiac monitoring during treatment. Since then, multiple classes of novel targeted cancer therapies, ranging from biologics to small molecule inhibitors and spanning different classes, have been associated with acute and chronic cardiovascular and cardiometabolic complications. Chronic sequelae have become even more clinically relevant due to improved prognosis of cancer patients. In the United States, there are nearly 20,000,000 cancer survivors, representing 6% of the population. Cardiovascular disease, not cancer, is the leading cause of death among this population. Cardio-oncology represents a new clinical frontier given the ever-expanding oncologic therapies being introduced into practice. These therapies are associated with unique clinical cardiovascular and cardiometabolic syndromes. For example, a decade ago, few would have predicted the cardiovascular complications that from immune checkpoint inhibitors (ICI), immunotherapies that are currently approved in 50% of cancer patients. Inflammatory cardiomyopathies including myocarditis and pericarditis represent important new acute clinical challenges in practice. Chronic cardiovascular effects of ICI are yet to be defined. Given these clinical entities, new approaches are needed for diagnosis and treatment.