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《慢性疾病与转化医学(英文)》2019,5(1):6-14
Immuno-oncology is a fast evolving field of cancer therapy and immune checkpoint inhibitors (ICIs) are clearly a breakthrough in this field. Cardiotoxicity with conventional anti-cancer therapies has been well studied in the past and clear guidelines for management of these side effects are available in the literature. However, cardiotoxicity with novel agents such as ICIs has been fairly under-reported and/or underestimated and we are yet to formulate clear guidelines for management of these rare side effects. In the last few years, there has been an overall increase in the number of cases of cardiotoxicity related to ICIs. In this literature review, we describe the mechanism of action of the most widely used ICIs and their related cardiotoxicities. The increase in number of case reports about the potential of cardiotoxicities with these novel agents clearly indicates the need for a new insight into the field of cardio-immuno-oncology. 相似文献
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BackgroundTrastuzumab is a drug used in HER2-positive breast cancer that increases patient survival. Due to cardiotoxicity is the most important side effect of trastuzumab treatment, cardiac monitoring should be a priority. The purpose of this study is to evaluate plasma NT-proBNP level and major cardiovascular risk factors as possible early predictors of trastuzumab-induced cardiotoxicity in HER2-positive breast cancer patients.MethodsWe conducted a retrospective observational study involving 66 patients with HER2-positive breast cancer treated with trastuzumab. Left ventricle ejection fraction (LVEF), NT-proBNP values, and the history of cardiovascular risk factors were collected. Cardiotoxicity was diagnosed considering a decrease of the LVEF from baseline or clinical manifestation of congestive heart failure. NT-proBNP cut-off points were considered to establish normal or abnormal values according to patient age.Results27.3% of the patients suffered cardiotoxicity during trastuzumab treatment. Most cases were diagnosed due to the appearance of cardiac symptomatology (66.7%). Logistic regression analysis showed a significant association of diabetes mellitus (OR 5.9, 95% CI 1.2–28.5, p = 0.028) and high NT-proBNP levels (OR 22.0, 95% CI 5.7–85.4, p < 0.0001) with the development of trastuzumab-induced cardiotoxicity.ConclusionNT-proBNP levels above the upper limit of the normal range adjusted to age or diabetes mellitus seem to be associated with a higher risk of developing cardiotoxicity. However, some limitations of the present study make necessary further studies aimed to clarify whether NT-proBNP and diabetes-associated markers determinations can be useful in the monitoring of cardiotoxicity risk in breast cancer patients undergoing trastuzumab therapy. 相似文献
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Leonard Lothstein Judith Soberman Deanna Parke Jatin Gandhi Trevor Sweatman Tiffany Seagroves 《Oncology research》2020,28(5):451-465
Triple-negative breast cancer (TNBC) is unresponsive to antiestrogen and anti-HER2 therapies, requiring the
use of cytotoxic drug combinations of anthracyclines, taxanes, cyclophosphamide, and platinum compounds.
Multidrug therapies achieve pathological cure rates of only 20–40%, a consequence of drug resistance and
cumulative dose limitations necessitated by the reversible cardiotoxic effects of drug therapy. Safer and more
effective treatments for TNBC are required to achieve durable therapeutic responses. This study describes the
mechanistic analyses of the novel anthracycline, pivarubicin, and its in vivo efficacy against human primary
TNBC. Pivarubicin directly activates PKCd, triggers rapid mitochondrial-dependent apoptosis, and circumvents resistance conferred by overexpression of P-glycoprotein, Bcl-2, Bcl-XL, and Bcr-Abl. As a consequence,
pivarubicin is more cytotoxic than doxorubicin against MDA-MB-231, and SUM159 TNBC cell lines grown
in both monolayer culture and tumorspheres. Comparative in vivo efficacy of pivarubicin and doxorubicin was
performed in an orthotopic NSG mouse model implanted with MDA-MB-231 human TNBC cells and treated
with the maximum tolerated doses (MTDs) of pivarubicin and doxorubicin. Tumor growth was monitored by
digital caliper measurements and determination of endpoint tumor weight and volume. Endpoint cardiotoxicity
was assessed histologically by identifying microvacuolization in ventricular cardiomyocytes. Primary tumors
treated with multiple rounds of doxorubicin at MTD failed to inhibit tumor growth compared with vehicletreated tumors. However, administration of a single MTD of pivarubicin produced significant inhibition of
tumor growth and tumor regression relative to tumor volume prior to initiation of treatment. Histological
analysis of hearts excised from drug- and vehicle-treated mice revealed that pivarubicin produced no evidence
of myocardial damage at a therapeutic dose. These results support the development of pivarubicin as a safer and
more effective replacement for doxorubicin against TNBC as well as other malignancies for which doxorubicin
therapy is indicated. 相似文献