HER-2阳性乳腺癌靶向治疗的心脏毒性综述

Cardiotoxicity of Targeted Therapy for HER-2 Positive Breast Cancer

癌症是一种威胁人类健康的重大疾病,是世界上导致人类死亡的第一或第二的常见因素。预计未来50年内,癌症患者的人数仍将上升。其中,乳腺癌高死亡率和高发病率而成为女性最主要的健康问题。HER2阳性乳腺癌是乳腺癌亚型的一种,因人表皮生长因子受体2 (human epidermal growth factor receptor-2, HER-2)高表达见于25%~30%的乳腺癌患者,且其与乳腺癌的不良预后相关。自曲妥珠单抗(trastuzumab)批准用于治疗转移性及早期乳腺癌以来,抗HER-2治疗已成为指南推荐的HER-2阳性早、晚期乳腺癌的标准治疗方案。美国食品与药品管理局(FDA)批准的乳腺癌临床使用的抗HER-2药物包括曲妥珠单抗、帕妥珠单抗、拉帕替尼、T-DM1、DS-8201等,其相关的心脏毒性值得关注,本文对批准用于乳腺癌抗HER-2治疗药物的治疗方法,发生心脏毒性的机制、临床表现、管理及其预防等方面进行综述分析。

Cancer is a major disease that threatens human health and is the first or second most common cause of human death in the world. It is expected that the number of cancer patients will continue to rise in the next 50 years. Among them, breast cancer has become the most important health problem for women due to its high mortality and incidence rate. HER2 positive breast cancer is a subtype of breast cancer. High expression of human epidermal growth factor receptor-2 (HER-2) is found in 25% to 30% of breast cancer patients, and it is related to the poor prognosis of breast can-cer. Since trastuzumab was approved for the treatment of metastatic and early breast cancer, anti HER-2 treatment has become the standard treatment scheme recommended by the guidelines for HER-2 positive early and late breast cancer. The anti HER-2 drugs approved by the US Food and Drug Administration (FDA) for clinical use of breast cancer include trastuzumab, patuzumab, lapa-tinib, T-DM1, DS-8201 and other drugs. At the same time, their related cardiac toxicity also de-serves attention. This article reviews and analyzes the treatment methods, mechanisms of cardiac toxicity, clinical manifestations, management and prevention of anti-HER-2 drugs approved for breast cancer.