心血管肿瘤学：新的临床前沿及心血管研究的创新平台
Cardio-Oncology: A New Clinical Frontier and Novel Platform for Cardiovascular Investigation
DOI 原文链接
用sci-hub下载
如无法下载，请从 Sci-Hub 选择可用站点尝试。
影响因子:38.6
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
DOI:
10.1161/CIRCULATIONAHA.124.065473
摘要
在过去的20年里，心血管肿瘤学作为一个新的心血管亚专业逐渐兴起。老旧的、非特异性的化疗药物（如蒽环类药物）和放射治疗已被广泛描述为具有心脏毒性的药物，蒽环类药物相关的心力衰竭最初在儿科人群中由心脏病专家Steven Lipshultz医生和肿瘤学家Stephen Sallan医生进行了广泛研究。人们曾希望随着新型靶向治疗的出现，这些毒性反应能得到缓解。然而，超过20年前，人们已意识到，一部分接受曲妥珠单抗（一种靶向乳腺癌的药物）治疗的患者可能发生心肌病，因而在治疗过程中需要进行影像学的心脏监测。自那时起，从生物制剂到小分子抑制剂，涉及不同类别的多种新型靶向癌症治疗药物，都与急性和慢性心血管及心代谢并发症相关。随着癌症患者预后改善，慢性后遗症的临床意义变得更加突出。在美国，癌症幸存者近2000万，占人口的6%。心血管疾病已成为该人群的主要死因，而非癌症。由于不断引入临床的创新肿瘤治疗方法，心血管肿瘤学成为一个新的临床前沿。这些治疗方法常伴有独特的心血管和心代谢综合征。例如，十年前，几乎无人预料到免疫检查点抑制剂（ICI）带来的心血管并发症——免疫治疗药物，目前已获批用于50%的癌症患者。炎症性心肌病，包括心肌炎和心包炎，是临床上重要的新发急性挑战。ICI的慢性心血管效应尚未完全明确。鉴于这些临床实体，亟需新的诊断和治疗策略。
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.