Heart:曲妥珠单抗诱发心脏毒性反应临床常见

2013-01-30 Heart CMT 高晓方 编译

  意大利学者的一项研究表明,在临床实践中曲妥珠单抗诱发心脏毒性反应(TIC)为常见不良事件,但总体较为轻微。论文于2013年1月23日在线发表于《心脏》(Heart)。   此项回顾性研究共纳入179例接受辅助曲妥珠单抗治疗的乳腺癌患者。以左室射血分数(LVEF)至基线绝对降低≥15或LVEF<50%定义TIC。对潜在心脏危险因素(高血压、高胆固醇血症、糖尿病、吸烟、心肌缺血和既往

  意大利学者的一项研究表明,在临床实践中曲妥珠单抗诱发心脏毒性反应(TIC)为常见不良事件,但总体较为轻微。论文于2013年1月23日在线发表于《心脏》(Heart)。

  此项回顾性研究共纳入179例接受辅助曲妥珠单抗治疗的乳腺癌患者。以左室射血分数(LVEF)至基线绝对降低≥15或LVEF<50%定义TIC。对潜在心脏危险因素(高血压、高胆固醇血症、糖尿病、吸烟、心肌缺血和既往胸部放疗)和保护性因素(β阻滞剂、ACE抑制剂和/或血管紧张素受体阻滞剂)加以考量之后,利用Logistic回归估算比值比(OR)以便评估TIC风险。

  结果显示,受试者中共发生78例TIC(44%)和4例心力衰竭(2%);14例患者因TIC而停用曲妥珠单抗。各种心脏危险因素和心血管合并用药均未改变TIC风险。与低剂量用药相比,既往多柔比星累积剂量>240 mg/m2或表柔比星>500 mg/m2均可升高TIC风险(p=0.0011)。


Trastuzumab-induced cardiotoxicity in early breast cancer patients: a retrospective study of possible risk and protective factors

OBJECTIVE:
Although adjuvant trastuzumab improves survival in patients with HER2-positive early breast cancer, there is growing concern about the long-term effect of trastuzumab-induced cardiotoxicity (TIC). We retrospectively assessed the incidence of TIC and heart failure (HF) to identify possible risk and protective factors.
DESIGN:
Retrospective study.
SETTING:
Institute for Cancer Research and Treatment, Medical Oncology Department.
PATIENTS:
Consecutive patients who started adjuvant trastuzumab between 2007 and 2010.
MAIN OUTCOME:
Measures TIC was defined as an absolute left ventricular ejection fraction (LVEF) decrease ≥15 points from baseline or a LVEF<50%. Logistic regression was used to estimate OR and their 95% CI in order to evaluate the risk of TIC, considering potential cardiac risk factors (hypertension, hypercholesterolaemia, diabetes mellitus, smoke, cardiac ischaemia and previous chest radiotherapy) and protective factors (β-blockers, ACE inhibitors and/or angiotensin receptor blockers).
RESULTS:
Among 179 patients, 78 cases of TIC (44%, 95% CI 37% to 51%) and four cases of HF (2%, 95% CI 0% to 4%) were reported. 14 patients stopped trastuzumab as a result of TIC. None of the cardiac risk factors or concomitant cardiovascular medications altered the risk of TIC. A previous cumulative dose >240 mg/m(2) of doxorubicin or >500 mg/m(2) of epirubicin increased the risk of TIC compared with lower doses (OR 3.07; 95% CI 1.29 to 7.27, p=0.0011).
CONCLUSIONS:
TIC is a frequent, albeit generally mild, adverse event in clinical practice. Further studies are warranted to better define the risk of and protective factors for TIC.

    

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (3)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1648080, encodeId=8cc11648080a1, content=<a href='/topic/show?id=d5c560226fc' target=_blank style='color:#2F92EE;'>#曲妥珠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60226, encryptionId=d5c560226fc, topicName=曲妥珠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a67b23554000, createdName=linlin2320, createdTime=Wed Apr 10 22:44:00 CST 2013, time=2013-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355728, encodeId=83251355e2868, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Feb 01 05:44:00 CST 2013, time=2013-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562135, encodeId=228a15621356d, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Feb 01 05:44:00 CST 2013, time=2013-02-01, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1648080, encodeId=8cc11648080a1, content=<a href='/topic/show?id=d5c560226fc' target=_blank style='color:#2F92EE;'>#曲妥珠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60226, encryptionId=d5c560226fc, topicName=曲妥珠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a67b23554000, createdName=linlin2320, createdTime=Wed Apr 10 22:44:00 CST 2013, time=2013-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355728, encodeId=83251355e2868, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Feb 01 05:44:00 CST 2013, time=2013-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562135, encodeId=228a15621356d, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Feb 01 05:44:00 CST 2013, time=2013-02-01, status=1, ipAttribution=)]
    2013-02-01 zhaojie88
  3. [GetPortalCommentsPageByObjectIdResponse(id=1648080, encodeId=8cc11648080a1, content=<a href='/topic/show?id=d5c560226fc' target=_blank style='color:#2F92EE;'>#曲妥珠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60226, encryptionId=d5c560226fc, topicName=曲妥珠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a67b23554000, createdName=linlin2320, createdTime=Wed Apr 10 22:44:00 CST 2013, time=2013-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355728, encodeId=83251355e2868, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Feb 01 05:44:00 CST 2013, time=2013-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562135, encodeId=228a15621356d, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Feb 01 05:44:00 CST 2013, time=2013-02-01, status=1, ipAttribution=)]
    2013-02-01 zhaojie88

相关资讯

NEJM:两种HER2抑制剂联用能显著延长乳腺癌生存期

    研究发现,对于HER2阳性转移性乳腺癌,曲妥珠单抗+多西他赛+培妥珠单抗较曲妥珠单抗+多西他赛+安慰剂治疗可使患者无进展生存期(PFS)中位延长6.1个月。   CLEOPATRA(培妥珠单抗联合曲妥珠单抗临床评估)研究是一项随机、双盲、Ⅲ期国际研究,研究中808例患者被随机分为曲妥珠单抗+多西他赛联合培妥珠单抗或安慰剂治疗组。结果显示,培妥珠单抗组和安慰剂

JNCI:蒽环类与曲妥珠单抗带来心脏衰竭风险

    临床试验结果已经显示,乳腺癌患者接受蒽环类和曲妥珠单抗(赫赛汀,罗氏)的治疗会增加心力衰竭和心肌病的风险。但是在临床试验之外的患者人群中,治疗与风险的关系是怎样?一项研究结果表明:在“现实世界”的观察性队列研究能够表明这样的风险可能会更高。该研究发表于8月31日美国国家癌症研究所杂志。     中位随访时间比之前的临床试验延长了

JCO:曲妥珠单抗治疗乳腺癌的CD风险较低

  人们普遍认为,对人表皮生长因子受体2呈阳性的乳腺癌进行辅助化疗,尤其是治疗方案中包括蒽环类药物时,使用曲妥珠单抗可能会产生心功能不全(CD)的风险。鉴于曲妥珠单抗的药效确切,为了给患者提供最佳的治疗方案,对心脏的安全性进行持续性评价,并鉴定出引起心功能不全的风险因素具有重要意义。为此,Edward H. Romond博士领导的美国乳腺与肠道外科辅助治疗研究项目B-31进行了相关研究,研究结果在

NEJM:在HER2阳性乳腺癌中的曲妥珠单抗辅助治疗

  丹尼斯·斯拉门(Slamon)等 乳腺癌国际研究组成员   背景 在人类表皮生长因子受体(HER)阳性乳腺癌的辅助治疗中,曲妥珠单抗可改善(患者的)生存情况,尽管采用基于蒽环类联合疗法的方案与心脏毒性相关。我们想对一种新的含曲妥珠单抗的非蒽环类治疗方案的有效性和安全性进行评估。   方法 我们将3222名有HER2阳性早期乳腺癌的妇女随机分为3组:第一组接受多

HER2阳性早期乳腺癌化疗后辅助曲妥珠单抗有益

  《柳叶刀·肿瘤学》(Lancet Oncol)杂志最新发表的一项临床研究表明,人表皮生长因子受体2(HER2)阳性早期乳腺癌患者化疗后用曲妥珠单抗辅助治疗1年与中位随访4年时获得显著临床益处相关。   研究者评估了HERA研究中HER2阳性早期乳腺癌患者中位随访4年的无病生存和总生存。HERA研究是一项国际、多中心、随机化、开放标签的Ⅲ期临床试验,比较了HER2阳性早期乳腺癌患者在

hs-CRP示曲妥珠单抗心脏毒性

  美国和澳大利亚学者4月4日在线发表于《乳腺癌研究和治疗》(Breast Cancer Research and Treatment)杂志的一项研究表明,定期监测高敏C反应蛋白(hs–CRP)有望用于预测曲妥珠单抗诱发的早期乳腺癌患者的无症状心脏毒性。   该研究前瞻性地纳入了54例人表皮生长因子受体2(HER2)阳性早期乳腺癌患者,并评估了患者血清脑利