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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

曲妥珠单抗心脏毒性反应
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　　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.

    

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    2013-04-10 linlin2320

    #曲妥珠#

    0

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    2013-02-01 zhaojie88

    #ART#

    0

  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=61, 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=48, 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=68, 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

    #HEART#

    0

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