Практические Рекомендации По Коррекции Кардиоваскулярной Токсичности Противоопухолевой Лекарственной Терапии

Виценя, М. В.; Агеев, Ф. Т.; Гиляров, М. Ю.; Овчинников, А. Г.; Орлова, Р. В.; Полтавская, М. Г.

doi:10.18027/2224-5057-2021-11-3s2-41

Cited by 9 publications

(2 citation statements)

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“…В связи с этим приобретает все большее значение изучение побочных эффектов, связанных с лечением больных с ЗНО. Лечение сердечно-сосудистой токсичности (ССТ), связанной с терапией рака (СТР), оказывает огромное влияние на тип противораковой терапии, а также на долгосрочные показатели заболеваемости и смертности пациентов с раком [4,5]. Эффективное ведение пациентов как с раком, так и с сердечно-сосудистыми заболеваниями (ССЗ) требует уникального интереса и опыта медицинских работников, что привело к формированию новой дисциплины -кардиоонкологии [6,7].…”

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Speckle-Tracking Echocardiography in Assessment of Breast Cancer Therapy-Related Subclinical Cardiac Dysfunction

Akbalaeva,

Shulzhenko,

Pershukov

et al. 2024

Innovacionnaâ medicina Kubani

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Background: Cancer therapy-related cardiac dysfunction (CTRCD) is a new term that encompasses a wide range of potential manifestations and is etiologically associated with a wide variety of cancer treatments. Detection of early subclinical cardiac dysfunction is of great clinical importance.Objective: To assess subclinical CTRCD in women with HER2-positive locally advanced or metastatic breast cancer undergoing a course of anthracyclines (doxorubicin), docetaxel, and trastuzumab. We prospectively enrolled women aged 18-75 years with an established diagnosis of HER2-positive locally advanced or metastatic breast cancer across 3 centers.Material and methods: We monitored 122 women with HER2-positive locally advanced or metastatic breast cancer undergoing a course of anthracyclines (doxorubicin), docetaxel, and trastuzumab using speckle-tracking echocardiography. Based on the treatment protocol, we formed 3 comparison blocks: block 1 (chemotherapy: doxorubicin+cyclophosphamide); block 2 (chemotherapy+targeted therapy: docetaxel+trastuzumab), and block 3 (targeted therapy: trastuzumab).Results: The rate of subclinical CTRCD detection was high and exceeded 20%-30% in all comparison blocks after the 3rd course of chemotherapy, chemotherapy+targeted therapy, and targeted therapy. The rate of subclinical CTRCD increased significantly from the 1st to the 2nd, from the 2nd to the 3rd, from the 3rd to the 4th therapy courses in each block. Comparisons between the blocks were significant only after the 4th course of chemotherapy and the 4th course of targeted therapy (Yates-corrected chi-square, P=.0394); all the other comparisons between the blocks were not significant in terms of subclinical CTRCD rate.Discussion: Given the growing number of patients with breast cancer, such frequent monitoring of the cardiac function is likely to improve the quality of cancer treatment and might have a positive impact on the overall survival of patients with breast cancer. Conclusions: Criteria for frequency of echocardiographic monitoring of cardiac dysfunction in patients with malignant tumors, especially with HER2-positive breast cancer, should be revised.

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Section: Introductionunclassified

Speckle-Tracking Echocardiography in Assessment of Breast Cancer Therapy-Related Subclinical Cardiac Dysfunction

Akbalaeva,

Shulzhenko,

Pershukov

et al. 2024

Innovacionnaâ medicina Kubani

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“…Вместе с тем, с одной стороны, совершенствование лекарственной терапии привело к снижению смертности от данной патологии и росту выживаемости в целом, а с другой, врачи столкнулись с новой проблемой -возникновением тяжелых побочных, прежде всего кардиотоксических, эффектов, оказывающих существенное влияние на долгосрочные показатели выживаемости пациентов [3,4]. На сегодняшний день диагностика кардиотоксических эффектов химиотерапии (ХТ) включает в себя проведение эхокардиографии и определение уровня сердечных биомаркеров (тропонина I или T, натрийуретических пептидов BNP и pro-BNP) до начала и в процессе лечения [5]. Американское эхокардиографическое общество (American Society of Echocardiography, ASE) и Европейская ассоциация сердечно-сосудистой визуализации (European Association of Cardiovascular Imaging, EACVI) главным критерием кардиотоксичности ХТ, ассоциированной с симптомами сердечной недостаточности, определили снижение фракции выброса левого желудочка (ФВ ЛЖ) на 10 % и более (при этом его значение должно быть меньше 50 %) [6].…”

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Molecular genetic markers of chemotherapy-induced cardiotoxicity in patients with oncohematological diseases (review)

Milyutkina,

Sustretov,

Limareva

2023

Usp. mol. onkol

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Cardiotoxicity of anticancer therapy is a severe adverse cardiovascular event affecting the survival of cancer patients. Modern methods for diagnosing cardiotoxicity allow to identify already occurred myocardial transformations, accompanied by symptoms of heart failure and are not predict and detect early changes in the heart tissue during treatment. Recently, increasing attention is paid to the search for molecular genetic markers, a single identification of which before starting treatment will make possible to determining the risks of cardiotoxicity and change treatment taking into account individual genetic characteristics. At the same time, most research on the effect of allelic variants of genes on cardio-vascular complications relate to chemotherapy of solid tumors. The review considered possible prognostic genetic variants of cardiotoxicity induced by chemotherapy in patients with the hematopoietic and lymphatic malignancies.

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Approaches to early diagnosis and prevention of cardiovascular toxicity induced by targeted drugs and immune checkpoint inhibitors in oncohematology: a literature review

Мещерина

Степченко

Leontieva

et al. 2023

Cardiovasc Ther Prev

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The development of targeted drugs and immune checkpoint inhibitors (ICIs), as well as their implementation into clinical practice has allowed increasing the overall and event-free survival of oncohematological patients. Currently, assessment of the efficacy of a therapeutic strategy in each specific case includes the evaluation of an acceptable tolerability profile. The subject of discussion includes cardiovascular complications induced by target drugs and ICIs. The review mainly presents the issues of cardiovascular toxicity (CVT) in certain groups of oncohematological patients (with chronic lymphocytic leukemia, chronic myeloid leukemia, multiple myeloma). The spectrum of cardiovascular adverse effects associated with targeted and ICI therapy in oncohematological practice is quite wide — coronary artery disease, peripheral arterial disease, myocarditis, heart failure, arrhythmias, hypertension. The high importance of the problem of using targeted and immunosuppressive therapy dictates the need to predict adverse effects. The diagnosis of heart failure (one of CVT manifestations) is based on determining the decreased left ventricular ejection fraction during echocardiography, less often — during cardiac magnetic resonance imaging; global longitudinal myocardial strain is a significant parameter of preclinical heart failure, which is determined using the speckle tracking technique. To determine vascular toxicity, a special attention is paid to the vascular wall structure and microcirculation parameters — capillary density at rest, percentage of capillary recovery and perfused capillaries, stiffness index for large blood vessels, reflection index for small arteries, laboratory markers of inflammation and endothelial dysfunction (C-reactive protein, fibrinogen, homocysteine, endothelin 1, vascular endothelial growth factor). CVT prevention presumes the determination of the risk group, correction of risk factors, and administration of protective therapy to very high and high-risk patients. One of the promising directions for preventing vascular toxicity is the use of sodium-glucose linked transporter-2 inhibitors.

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Практические Рекомендации По Коррекции Кардиоваскулярной Токсичности Противоопухолевой Лекарственной Терапии

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Cited by 9 publications

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Speckle-Tracking Echocardiography in Assessment of Breast Cancer Therapy-Related Subclinical Cardiac Dysfunction

Speckle-Tracking Echocardiography in Assessment of Breast Cancer Therapy-Related Subclinical Cardiac Dysfunction

Molecular genetic markers of chemotherapy-induced cardiotoxicity in patients with oncohematological diseases (review)

Approaches to early diagnosis and prevention of cardiovascular toxicity induced by targeted drugs and immune checkpoint inhibitors in oncohematology: a literature review

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