两个乳腺癌化疗药物引发的心脏问题

导读：因为越来越多的患有乳腺癌的女性存活时间延长了，乳腺癌逐渐成为一种慢性疾病，所以这项研究具有重要意义。

2012年8月31日 讯 /生物谷BIOON/ --运用两种化疗药物治疗乳腺癌的妇女患者可能会遇到比以往研究发现的更多的心脏问题如心脏衰竭等，据Journal of the National Cancer Institute杂志上刊出的一则研究证实。

研究主要领导者流行病学家Erin Aiello Bowles表示：因为越来越多的患有乳腺癌的女性存活时间延长了，乳腺癌逐渐成为一种慢性疾病，所以这项研究具有重要意义。乳房癌是美国最常见的癌症之一，在2011年，估计有232620例诊断患乳腺癌。通常情况下，化疗会引起其他健康问题。

Bowles女士和她的同事们估计，现实世界中蒽环类药物和曲妥珠单抗的使用与患者出现心脏衰竭和心肌病相关。早期的临床试验表明，女性使用蒽环类药物或曲妥珠单抗等治疗乳腺癌的药物后心脏衰竭、心肌病等疾病的风险增加。

12500名诊断出患有浸润性乳腺癌的妇女的回顾性队列研究发现相比不接受化疗的乳腺癌女性，单使用蒽环类药物的妇女罹患心脏衰竭或心肌病的风险明显较高，但一结论与先前的临床试验结果类似。但单独使用曲妥珠单抗的女性出现这些心脏问题的整体风险更大。联合使用使用蒽环类药物和曲妥珠单抗的乳腺癌妇女出现心脏问题的风险高于前期研究报告所得出的结论。Bowles女士补充说化疗可通过几种机制引起心脏问题。这些药物是有毒的，他们杀死癌细胞，有时甚至会杀死体内其他细胞，但这些药物对患者来说仍然是重要的，因为这些药物能改善乳腺癌妇女的生存情况，但对于任何药物，我们都需要明确了解有关风险。（生物谷：Bioon.com）

doi:10.1093/jnci/djs317
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Risk of Heart Failure in Breast cancer Patients After Anthracycline and trastuzumab treatment: A retrospective cohort Study

Erin J. Aiello Bowles, Robert Wellman, Heather Spencer Feigelson, Adedayo A. Onitilo, Andrew N. Freedman, Thomas Delate,et al

Background  Clinical  trials  demonstrated  that  women  treated  for  breast  cancer  with  anthracycline  or  trastuzumab  are  at increased  risk  for  heart  failure and/or cardiomyopathy  (HF/CM),  but  the  generalizability  of  these  findings  is unknown. We estimated real-world adjuvant anthracycline and trastuzumab use and their associations with incident HF/CM.

Methods  We conducted a population-based, retrospective cohort study of 12?500 women diagnosed with incident, invasive breast cancer from January 1, 1999 through December 31, 2007, at eight integrated Cancer Research Network health systems. Using administrative procedure and pharmacy codes, we identified anthracycline, trastuzumab, and other
chemotherapy use. We identified incident HF/CM following chemotherapy initiation and assessed risk of HF/CM with time-varying chemotherapy exposures vs no chemotherapy. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for age at diagnosis, stage, Cancer Research Network site, year of diagnosis, radiation therapy, and comorbidities. 

Results   Among 12500 women (mean age=60years, range=22–99years), 29.6% received anthracycline alone, 0.9% received  trastuzumab  alone,  3.5%  received  anthracycline  plus  trastuzumab,  19.5%  received  other  chemotherapy, and 46.5% received no chemotherapy. Anthracycline and trastuzumab recipients were younger, with fewer comorbidities than recipients of other chemotherapy or none. Compared with no chemotherapy, the risk of HF/CM was higher in patients treated with anthracycline alone (adjusted HR=1.40, 95% CI=1.11 to 1.76), although the increased risk was similar to other chemotherapy (adjusted HR=1.49, 95% CI=1.25 to 1.77); the risk was highly increased in patients treated with trastuzumab alone (adjusted HR=4.12, 95% CI=2.30 to 7.42) or anthracycline plus trastuzumab (adjusted HR=7.19, 95% CI=5.00 to 10.35).

Conclusions     Anthracycline and trastuzumab were primarily used in younger, healthier women and associated with increased HF/CM risk compared with no chemotherapy. This population-based observational study complements findings from clinical trials on cancer treatment safety.