Cardiotoxicidade associada à terapêutica oncológica: mecanismos fisiopatológicos e estratégias de prevenção

Adão, Rui; Keulenaer, Gilles W. De; Leite‐Moreira, Adelino F.; Brás-Silva, Carmen

doi:10.1016/j.repc.2012.11.002

Cited by 57 publications

(55 citation statements)

References 91 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Anthracyclines, such as doxorubicin, epirubicin and daunorubicin, have substantially contributed to the improved cancer survival rates over the past 25 years in both adults and children [9]. These drugs have a range of anticancer properties that include preventing cell replication through DNA basepair intercalation and disrupting DNA uncoiling through inhibition of topoisomerase 2 activity.…”

Section: Mechanisms Of Anthracycline-induced Cardiotoxicitymentioning

confidence: 99%

“…Additionally, the heart has a reduced ability to scavenge free radicals created by the anthracyclines, given that there are lower concentrations than is normally present of catalase and glutathione peroxidase in the presence of anthracyclines [10]. The increased stress and reduced free radical scavenging leads to cardiomyocyte-damaged DNA, reduced protein expression, damage to the cardiac sarcomere, destruction of myofilaments giving way to cell and organ damage, and left ventricular (LV) diastolic dysfunction with impaired contractility [9,10]. …”

Section: Mechanisms Of Anthracycline-induced Cardiotoxicitymentioning

confidence: 99%

“…Utilizing chemotherapy and radiation therapy together has been shown to improve oncological outcomes in many cancer patients, and about half of these patients now receive some amount of radiation [9]. However, much like the chemotherapeutic drugs, radiotherapy can also cause cardiotoxic side effects: myocardial fibrosis, cardiomyopathy, early coronary disease, and valvular and electrophysiological dysfunction [9].…”

Section: Mechanisms Of Radiotherapy-induced Cardiotoxicitymentioning

confidence: 99%

“…However, much like the chemotherapeutic drugs, radiotherapy can also cause cardiotoxic side effects: myocardial fibrosis, cardiomyopathy, early coronary disease, and valvular and electrophysiological dysfunction [9]. The cardiotoxicity is believed to be caused by acute injury and inflammation leading to long-term myocardial fibrosis [10].…”

Section: Mechanisms Of Radiotherapy-induced Cardiotoxicitymentioning

confidence: 99%

See 3 more Smart Citations

Cardiotoxicity and Cardioprotection in Childhood Cancer

Lipshultz¹,

Sambatakos

Maguire

et al. 2014

Acta Haematol

View full text Add to dashboard Cite

Children diagnosed with cancer are now living longer as a result of advances in treatment. However, some commonly used anticancer drugs, although effective in curing cancer, can also cause adverse late effects. The cardiotoxic effects of anthracycline chemotherapy, such as doxorubicin, and radiation can cause persistent and progressive cardiovascular damage, emphasizing a need for effective prevention and treatment to reduce or avoid cardiotoxicity. Examples of risk factors for cardiotoxicity in children include higher anthracycline cumulative dose, higher dose of radiation, younger age at diagnosis, female sex, trisomy 21 and black race. However, not all who are exposed to toxic treatments experience cardiotoxicity, suggesting the possibility of a genetic predisposition. Cardioprotective strategies under investigation include the use of dexrazoxane, which provides short- and long-term cardioprotection in children treated with doxorubicin without interfering with oncological efficacy, the use of less toxic anthracycline derivatives and nutritional supplements. Evidence-based monitoring and screening are needed to identify early signs of cardiotoxicity that have been validated as surrogates of subsequent clinically significant cardiovascular disease before the occurrence of cardiac damage, in patients who may be at higher risk.

show abstract

Section: Mechanisms Of Anthracycline-induced Cardiotoxicitymentioning

confidence: 99%

Section: Mechanisms Of Anthracycline-induced Cardiotoxicitymentioning

confidence: 99%

Section: Mechanisms Of Radiotherapy-induced Cardiotoxicitymentioning

confidence: 99%

Section: Mechanisms Of Radiotherapy-induced Cardiotoxicitymentioning

confidence: 99%

See 2 more Smart Citations

Cardiotoxicity and Cardioprotection in Childhood Cancer

Lipshultz¹,

Sambatakos

Maguire

et al. 2014

Acta Haematol

View full text Add to dashboard Cite

show abstract

“…O tratamento do câncer de mama gera efeitos adversos, sendo a cardiotoxidade um dos mais significativos, podendo traduzir-se clinicamente por arritmias, dor, fadiga, alterações eletrocardiográficas e insuficiência cardíaca [4][5][6][7][8]. Um estudo mostrou que cerca de 90% das pacientes após o tratamento para câncer de mama relatavam no mínimo um efeito adverso e 60% relatavam múltiplas sequelas.…”

Section: Introductionunclassified

Treinamento aeróbico em sobrevivente de câncer de mama – relato de caso

Reis

Souza

Ramallo

et al. 2016

Sci Med

View full text Add to dashboard Cite

Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. RESUMOObjetivos: Relatar a evolução de uma paciente sobrevivente de neoplasia da mama após ter sido submetida a treinamento aeróbico durante oito semanas. Descrição do Caso: Uma paciente com 47 anos, tendo sido submetida à mastectomia por neoplasia da mama há cerca de cinco anos, seguida por radioterapia e quimioterapia, realizou treinamento aeróbico em cicloergômetro e esteira ergométrica durante oito semanas, com duas sessões semanais e aumento gradativo do volume de treino. Avaliações da capacidade cardiorrespiratória, da força estática, mobilidade superior, nível de atividade física e composição corporal foram realizadas antes e após o protocolo de treinamento. A paciente demonstrou melhora na fração de ejeção do ventrículo esquerdo, diminuição da frequência cardíaca de repouso e de esforço e aumento da amplitude de movimento do ombro e no nível de atividade física. Foi detectada também diminuição da gordura corporal visceral. Não houve aumento da força muscular nem da capacidade máxima de oxigênio. Conclusões: Este relato demonstra que no caso dessa paciente, submetida a tratamento cirúrgico, radioterápico e quimioterápico para câncer de mama, foram constatados benefícios na capacidade cardiorrespiratória, na mobilidade dos membros superiores, no nível de atividade física e na composição corporal, após treinamento aeróbico durante duas sessões semanais por oito semanas.DESCRITORES: neoplasias da mama; terapia por exercício; exercício aeróbico. ABSTRACT Aims:To report the evolution of a breast cancer survivor after an eight-week aerobic training program. Case Description: A 47-year-old breast cancer patient, submitted to mastectomy about five years before, followed by radiation therapy and chemotherapy, was submitted to aerobic training on cycle ergometer and treadmill for eight weeks, two sessions per week, with gradual increase in training volume. Cardiorespiratory capacity, static strength, upper body mobility, level of physical activity, and body composition were assessed before and after the training protocol. The patient demonstrated improvement in left ventricular ejection fraction, decrement of heart rate at rest and during exercise, and increase in shoulder range of motion and in physical activity level. A reduction of visceral fat was also observed. There was no improvement in muscle strength or in maximum capacity of oxygen use. Conclusions: This case report describes improvements in cardiorespiratory capacity, in shoulder range of motion, in the level of physical activity, and in body composition, after an eight-week aerobic training (two weekly sessions), in a breast cancer patient who had undergone mastectomy, radiation therapy, and chemotherapy.

show abstract

Pharmacologically pertinent period of effect (PPPE)

Suissa

LeLorier

2019

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

BackgroundThe period of time during which a patient is exposed to a drug does not necessarily correspond to the period during which the drug produces the adverse effect under consideration. We propose the term Pharmacologically pertinent period of effect (PPPE) to address this time window. We explored the PPPE in light of the rofecoxib saga.MethodsWe identified the observational database studies of rofecoxib at doses 25 and 50 mg daily and thromboembolic events. We also obtained the Kaplan‐Meier curves of Vioxx Gastrointestinal Outcomes Research trial (VIGOR) and Adenomatous Polyp Prevention on Vioxx (APPROVE) trials.ResultsWe found seven observational studies with nine analyses. All the studies only looked at current exposure. At the dose of 25 mg, only three of nine analyses were barely statistically significant. At the dose of 50 mg, the risk ratios were much higher. The visual inspection of the Kaplan‐Meier curves shows that in the APPROVE trial (25 mg), the placebo and rofecoxib curves start separating to become statistically significantly different only after 36 months. In contrast the VIGOR (50 mg), curves start separating very early and the divergence increases after 8 months.DiscussionThe 50 mg observational studies, looking at current exposure, correctively identified the almost immediate increase in risk evident in the VIGOR Kaplan‐Meier curves. The absence of an immediate increase in risk shown by the APPROVE trial was also correctively identified by most observational 25 mg studies. To our knowledge no observational study was done on the long‐term cardiac toxicity of the 25‐mg dose. It would thus appear that the two doses of rofecoxib have different PPPEs.

show abstract

Cardiotoxicidade associada à terapêutica oncológica: mecanismos fisiopatológicos e estratégias de prevenção

Cited by 57 publications

References 91 publications

Cardiotoxicity and Cardioprotection in Childhood Cancer

Cardiotoxicity and Cardioprotection in Childhood Cancer

Treinamento aeróbico em sobrevivente de câncer de mama – relato de caso

Pharmacologically pertinent period of effect (PPPE)

Contact Info

Product

Resources

About