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АЛТАЙСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ
Бюллетень медицинской науки
Цель. Анализ современных данных по частоте, патогенетическим механизмам, диагностике, профилактике и лечению кардиотоксичности у пациентов с колоректальным раком, получающих противоопухолевую терапию, с акцентом на существующие пробелы знаний и перспективные направления исследований.
Материалы и методы. Проведен систематический обзор отечественной и зарубежной литературы последних лет (PubMed, Scopus, eLIBRARY, Google Scholar), включающий публикации по теме кардиотоксичности при раке толстой кишки, современные международные и национальные клинические рекомендации, метаанализы, регистровые исследования и рандомизированные клинические испытания. Проанализированы механизмы кардиальных осложнений, современные подходы к их диагностике, мониторингу, профилактике и терапии.
Результаты. Кардиотоксичность противоопухолевой терапии при раке толстой кишки характеризуется высокой клинической значимостью и вариабельностью проявлений, от субклинических форм до жизнеугрожающих состояний. Диагностика осложнена низкой чувствительностью традиционных инструментальных и лабораторных методов, отсутствием валидированных алгоритмов стратификации риска и единых критериев для онкологических больных. Профилактика и лечение осложнений базируются на коррекции факторов риска, динамической модификации терапии, фармакологической поддержке, однако доказательная база остается ограниченной, а долгосрочные результаты малоизучены.
Заключение. Необходимы разработка персонализированных протоколов стратификации риска, совершенствование методов ранней диагностики, валидация новых биомаркеров и инструментальных технологий, а также проведение многоцентровых исследований эффективности современных стратегий профилактики и терапии кардиотоксичности у пациентов с колоректальным раком. Решение обозначенных проблем позволит повысить эффективность противоопухолевой терапии и улучшить прогноз больных.
Alzahrani S.M., Al Doghaither H.A., Al-Ghafari A.B. General insight into cancer: An overview of colorectal cancer (Review). Mol Clin Oncol. 2021; 15(6): 271. https://doi.org/10.3892/mco.2021.2433
Zamorano J.L., Gottfridsson C., Asteggiano R., et al. The cancer patient and cardiology. Eur J Heart Fail. 2020; 22(12): 2290-2309. https://doi.org/10.1002/ejhf.1985
Herrmann J. Adverse cardiac effects of cancer therapies: cardiotoxicity and arrhythmia. Nat Rev Cardiol. 2020; 17: 474-502. https://doi.org/10.1038/s41569-020-0348-1
Wilcox N.S., Amit U., Reibel J.B., et al. Cardiovascular disease and cancer: shared risk factors and mechanisms. Nat Rev Cardiol. 2024; 21: 617-631. https://doi.org/10.1038/s41569-024-01017-x
Jain D., Aronow W. Cardiotoxicity of cancer chemotherapy in clinical practice. Hosp Pract (1995). 2019; 47(1): 6-15. https://doi.org/10.1080/21548331.2018.1530831
Muhandiramge J., Zalcberg J.R., van Londen G.J., et al. Cardiovascular Disease in Adult Cancer Survivors: a Review of Current Evidence, Strategies for Prevention and Management, and Future Directions for Cardio-oncology. Curr Oncol Rep. 2022; 24(11): 1579-1592. https://doi.org/10.1007/s11912-022-01309-w
Hussain M., Collier P. Chemotherapy-Related cardiovascular complications. Oncologic Critical Care. 2020: 815-836. https://doi.org/10.1007/978-3-319-74588-6_70
Bohdan M., Kowalczys A., Mickiewicz A., Gruchała M., Lewicka E. Cancer Therapy-Related Cardiovascular Complications in Clinical Practice: Current Perspectives. J Clin Med. 2021; 10(8): 1647. https://doi.org/10.3390/jcm10081647
Nishi M., Wang P.Y., Hwang P.M. Cardiotoxicity of Cancer Treatments: Focus on Anthracycline Cardiomyopathy. Arterioscler Thromb Vasc Biol. 2021; 41(11): 2648-2660. https://doi.org/10.1161/ATVBAHA.121.316697
Koss-Mikołajczyk I., Todorovic V., Sobajic S., et al. Natural Products Counteracting Cardiotoxicity during Cancer Chemotherapy: The Special Case of Doxorubicin, a Comprehensive Review. Int J Mol Sci. 2021; 22(18): 10037. https://doi.org/10.3390/ijms221810037
Chaulin A.M., Abashina O.E., Duplyakov D.V. Pathophysiological mechanisms of cardiotoxicity in chemotherapeutic agents. Russian Open Medical Journal. 2020; 9(3): 305. https://doi.org/10.15275/rusomj.2020.0305
Giudice V., Vecchione C., Selleri C. Cardiotoxicity of Novel Targeted Hematological Therapies. Life. 2020; 10(12): 344. https://doi.org/10.3390/life10120344
Ell P., Martin J.M., Cehic D.A., Ngo D.T.M., Sverdlov A.L. Cardiotoxicity of Radiation Therapy: Mechanisms, Management, and Mitigation. Curr Treat Options Oncol. 2021; 22(8): 70. https://doi.org/10.1007/s11864-021-00868-7
Kim Y., Seidman J.G., Seidman C.E. Genetics of cancer therapy-associated cardiotoxicity. J Mol Cell Cardiol. 2022; 167: 85-91. https://doi.org/10.1016/j.yjmcc.2022.03.010
Xiang M., Lu Y., Xin L., et al. Role of Oxidative Stress in Reperfusion following Myocardial Ischemia and Its Treatments. Oxid Med Cell Longev. 2021; 2021: 6614009. https://doi.org/10.1155/2021/6614009
Marin W., Marin D., Ao X., Liu Y. Mitochondria as a therapeutic target for cardiac ischemiareperfusion injury (Review). Int J Mol Med. 2021; 47(2): 485-499. https://doi.org/10.3892/ijmm.2020.4823
Grakova E.V., Shilov S.N., Kopeva K.V., et al. Anthracycline-Induced Cardiotoxicity: The Role of Endothelial Dysfunction. Cardiology. 2021; 146(3): 315-323. https://doi.org/10.1159/000512771
Fabin N., Bergami M., Cenko E., Bugiardini R., Manfrini O. The Role of Vasospasm and Microcirculatory Dysfunction in Fluoropyrimidine-Induced Ischemic Heart Disease. J Clin Med. 2022; 11(5): 1244. https://doi.org/10.3390/jcm11051244
Pantazi D., Tselepis A.D. Cardiovascular toxic effects of antitumor agents: Pathogenetic mechanisms. Thromb Res. 2022; 213 Suppl 1: S95-S102. https://doi.org/10.1016/j.thromres.2021.12.017
Teng A.E., Noor B., Ajijola O.A., Yang E.H. Chemotherapy and Radiation-Associated Cardiac Autonomic Dysfunction. Curr Oncol Rep. 2021; 23(2): 14. https://doi.org/10.1007/s11912-020-01013-7
Miao M., Liu X., Zhang H., Dai H. Immuno-inflammatory mechanisms in cardio-oncology: new hopes for immunotargeted therapies. Front Oncol. 2025; 15: 1516977. https://doi.org/10.3389/fonc.2025.1516977
Verzicco I., Regolisti G., Quaini F., et al. Electrolyte Disorders Induced by Antineoplastic Drugs. Front Oncol. 2020; 10: 779. https://doi.org/10.3389/fonc.2020.00779
Gao F., Xu T., Zang F., Luo Y., Pan D. Cardiotoxicity of Anticancer Drugs: Molecular Mechanisms, Clinical Management and Innovative Treatment. Drug Des Devel Ther. 2024; 18: 4089-4116. https://doi.org/10.2147/DDDT.S469331
Kang Y., Scherrer-Crosbie M. Echocardiography Imaging of Cardiotoxicity. Cardiol Clin. 2019; 37(4): 419-427. https://doi.org/10.1016/j.ccl.2019.07.006
Spînu Ș., Cismaru G., Boarescu P.M., et al. ECG Markers of Cardiovascular Toxicity in Adult and Pediatric Cancer Treatment. Dis Markers. 2021; 2021: 6653971. https://doi.org/10.1155/2021/6653971
Cardinale D., Biasillo G., Salvatici M., Sandri M.T., Cipolla C.M. Using biomarkers to predict and to prevent cardiotoxicity of cancer therapy. Expert Rev Mol Diagn. 2017; 17(3): 245-256. https://doi.org/10.1080/14737159.2017.1283219
Dong J., Chen H. Cardiotoxicity of Anticancer Therapeutics. Front Cardiovasc Med. 2018; 5: 9. https://doi.org/10.3389/fcvm.2018.00009
Lyon A.R., Dent S., Stanway S., et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. Eur J Heart Fail. 2020; 22(11): 1945-1960. https://doi.org/10.1002/ejhf.1920
Armenian S.H., Lacchetti C., Barac A., et al. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017; 35(8): 893-911. https://doi.org/10.1200/JCO.2016.70.5400
Morelli M.B., Bongiovanni C., Da Pra S., Miano C., Sacchi F., Lauriola M., D’Uva G. Cardiotoxicity of Anticancer Drugs: Molecular Mechanisms and Strategies for Cardioprotection. Front Cardiovasc Med. 2022; 9: 847012. https://doi.org/10.3389/fcvm.2022.847012
Jain D., Russell R.R., Schwartz R.G., Panjrath G.S., Aronow W. Cardiac Complications of Cancer Therapy: Pathophysiology, Identification, Prevention, Treatment, and Future Directions. Curr Cardiol Rep. 2017; 19(5): 36. https://doi.org/10.1007/s11886-017-0846-x
Kourek C., Touloupaki M., Rempakos A., et al. Cardioprotective Strategies from Cardiotoxicity in Cancer Patients: A Comprehensive Review. J Cardiovasc Dev Dis. 2022; 9(8): 259. https://doi.org/10.3390/jcdd9080259
Guida F., Masetti R., Andreozzi L., et al. The Role of Nutrition in Primary and Secondary Prevention of Cardiovascular Damage in Childhood Cancer Survivors. Nutrients. 2022; 14(16): 3279. https://doi.org/10.3390/nu14163279
Qiu Y., Jiang P., Huang Y. Anthracycline-induced cardiotoxicity: mechanisms, monitoring, and prevention. Front Cardiovasc Med. 2023; 10: 1242596. https://doi.org/10.3389/fcvm.2023.1242596
Fogarassy G., Vathy-Fogarassy Á., Kenessey I., et al. Preventing cancer therapy-related heart failure: the need for novel studies. J Cardiovasc Med. 2021; 22(6): 459-468. https://doi.org/10.2459/JCM.0000000000001115
Payne D.L., Nohria A. Prevention of Chemotherapy Induced Cardiomyopathy. Curr Heart Fail Rep. 2017; 14(5): 398-403. https://doi.org/10.1007/s11897-017-0353-9
Fradley M.G., Beckie T.M., Brown S.A., et al. Recognition, Prevention, and Management of Arrhythmias and Autonomic Disorders in Cardio-Oncology: A Scientific Statement From the American Heart Association. Circulation. 2021; 144(3): e41-e55. https://doi.org/10.1161/CIR.0000000000000986
Singh S., Singh K. Atherosclerosis, Ischemia, and Anticancer Drugs. Heart Views. 2021; 22(2): 127-133. https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_45_20
Tini G., Tocci G., Battistoni A., et al. Role of Arterial Hypertension and Hypertension-Mediated Organ Damage in Cardiotoxicity of Anticancer Therapies. Curr Heart Fail Rep. 2023; 20(1): 56-62. https://doi.org/10.1007/s11897-023-00590-5
Albini A., Pennesi G., Donatelli F., et al. Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention. J Natl Cancer Inst. 2010; 102(1): 14-25. https://doi.org/10.1093/jnci/djp440
Lorenzo-Esteller L., Ramos-Polo R., Pons Riverola A., et al. Pericardial Disease in Patients with Cancer: Clinical Insights on Diagnosis and Treatment. Cancers (Basel). 2024; 16(20): 3466. https://doi.org/10.3390/cancers16203466
Terwoord J.D., Beyer A.M., Gutterman D.D. Endothelial dysfunction as a complication of anti-cancer therapy. Pharmacol Ther. 2022; 237: 108116. https://doi.org/10.1016/j.pharmthera.2022.108116
Palaskas N., Lopez-Mattei J., Durand J.B., et al. Immune Checkpoint Inhibitor Myocarditis: Pathophysiological Characteristics, Diagnosis, and Treatment. J Am Heart Assoc. 2020; 9(2): e013757. . https://doi.org/10.1161/JAHA.119.013757
Chianca M., Fabiani I., Del Franco A., et al. Management and treatment of cardiotoxicity due to anticancer drugs: 10 questions and answers. Eur J Prev Cardiol. 2022; 29(17): 2163-2172. https://doi.org/10.1093/eurjpc/zwac170
Kubota S., Hara H., Hiroi Y. Current status and future perspectives of onco-cardiology: Importance of early detection and intervention for cardiotoxicity, and cardiovascular complication of novel cancer treatment. Glob Health Med. 2021; 3(4): 214-225. https://doi.org/10.35772/ghm.2021.01024
Trapani D., Zagami P., Nicolò E., Pravettoni G., Curigliano G. Management of Cardiac Toxicity Induced by Chemotherapy. J Clin Med. 2020; 9(9): 2885. https://doi.org/10.3390/jcm9092885
Mir A., Badi Y., Bugazia S., et al. Efficacy and safety of cardioprotective drugs in chemotherapy-induced cardiotoxicity: an updated systematic review & network meta-analysis. Cardiooncology. 2023; 9(1): 10. https://doi.org/10.1186/s40959-023-00159-0
Al-Hasnawi Z., Hasan H.M., Abdul Azeez J.M., et al. Cardioprotective strategies in the management of chemotherapy-induced cardiotoxicity: current approaches and future directions. Ann Med Surg (Lond). 2024; 86(12): 7212-7220. https://doi.org/10.1097/MS9.0000000000002668
Huang W., Xu R., Zhou B., et al. Clinical Manifestations, Monitoring, and Prognosis: A Review of Cardiotoxicity After Antitumor Strategy. Front Cardiovasc Med. 2022; 9: 912329. https://doi.org/10.3389/fcvm.2022.912329
Palmieri V., Vietri M.T., Montalto A., et al. Cardiotoxicity, Cardioprotection, and Prognosis in Survivors of Anticancer Treatment Undergoing Cardiac Surgery: Unmet Needs. Cancers (Basel). 2023; 15(8): 2224. https://doi.org/10.3390/cancers15082224
