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Kardiovaskuläre Spätfolgen der Chemotherapie bei Darmkrebspatienten

Cardiovascular late effects of chemotherapy in colorectal cancer patients

  • Leitthema
  • Published:
Der Onkologe Aims and scope

An Erratum to this article was published on 07 April 2021

This article has been updated

Zusammenfassung

Hintergrund

Die akute Kardiotoxizität bestimmter Chemotherapeutika, die u. a. bei Darmkrebspatienten zum Einsatz kommen, ist seit Langem bekannt. Die Überlebensprognose für Darmkrebspatienten hat sich in den letzten Jahren verbessert, kardiotoxische Spätfolgen nach einer Chemotherapie sind jedoch weitestgehend unerforscht.

Fragestellung

Welche kardiovaskulären/‑toxischen Ereignisse treten am häufigsten auf, wie werden diese in verschiedenen Studiendesigns untersucht, und wie lang sind die Beobachtungszeiträume zur Erfassung der Ereignisse?

Material und Methode

Es erfolgte eine Literaturrecherche zu kardiovaskulären Folgen der Chemotherapie bei Darmkrebspatienten in führenden medizinischen Literaturdatenbanken.

Ergebnisse

Die Gesamtinzidenz kardiovaskulärer Ereignisse liegt in den 28 eingeschlossenen Studien zwischen 0,1 und 57,0 %. Die 3 häufigsten Symptome sind: venöse Thromboembolie (10 Studien; 0,1–35,6 %), Angina pectoris (6 Studien; 0,8–8,5 %) und Herzinsuffizienz (5 Studien; 0,1–54,5 %). Über die Hälfte der bisher veröffentlichten Studien berichten nur über Ereignisse während der Chemotherapie (bis etwa 6 Monate). Von den Studien mit längerem Zeitraum thematisieren 60 % venöse Thromboembolien.

Schlussfolgerungen

Venöse Thromboembolien sollten bei Darmkrebspatienten besonders beachtet und Patienten sowie Hausärzte zu kardiovaskulären Spätfolgen und Präventionsmaßnahmen aufgeklärt werden. Zukünftige Studien sollten eine Differenzierung in Akut‑, Früh- und Spätfolgen vornehmen und kardiovaskuläre Risikoprofile erheben. Studiendesigns mit längerem Beobachtungszeitraum sowie die Verlinkung von Krebsregistern oder Gesundheitsdatenbanken gilt es zu fördern.

Abstract

Background

The acute cardiotoxicity of specific chemotherapeutic agents which are used in the treatment of colon cancer is well described. Although the survival prognosis for colorectal cancer patients has improved in recent years, cardiotoxic long-term effects after chemotherapy are largely unexplored.

Objectives

What are the most common cardiotoxic events following chemotherapy, how are these assessed in different study designs, and how long is the study period?

Materials and methods

A literature research on cardiovascular effects of chemotherapy in colorectal cancer patients was performed in two leading medical databases.

Results

The overall incidence of cardiovascular events in the 28 included studies is between 0.1% and 57.0%. The three most commonly reported cardiovascular symptoms are venous thromboembolism (10 studies; 0.1–35.6%), angina pectoris (6 studies; 0.8–8.5%) and heart failure (5 studies; 0.1–54.5%). More than half of the studies only reported events during chemotherapy (about 6 months). Of the studies with longer observation periods, over 60% focus on venous thromboembolism.

Conclusion

Venous thromboembolism needs special attention in patients with colorectal cancer, and patients as well as primary physicians need to be educated in early signs of cardiovascular symptoms and prevention measurements. Future studies should differentiate acute, early and late effects of cardiotoxicity and collect data on cardiovascular risk profiles. Study designs with longer observation periods and the linkage of cancer registry or health databases should be encouraged.

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Abb. 1

Change history

Abbreviations

5d’FUR:

Doxifluridin (5’-Desoxy-5-Fluoruridin)

5‑FU:

5‑Fluorouracil

Adj.:

Adjuvant

AK:

Antikörper

AV:

Atrioventrikulärer Block

BEV:

Bevacizumab

BMI:

Body-Mass-Index – Körpermasseindex

BO:

Bolusgabe

CAIRO:

Studie zu CApecitabin, IRinotecan, Oxaliplatin

CAP:

Capecitabin

CTCAE:

Common Terminology Criteria of Adverse Events – allgemeine Terminologiekriterien von unerwünschten Ereignissen

CTx:

Chemotherapie

DM:

Diabetes mellitus

ECS:

European Society of Cardiology

EGFR:

Epidermal-Growth-Factor-Receptor – EGF-Rezeptor

EKG:

Elektrokardiogramm

FS:

Folinsäure

FOLFIRI:

Folinsäure, 5‑FU, Irinotecan

FOLFOX:

Folinsäure, 5‑FU, Oxaliplatin

ICD:

International Classification of Diseases – internationale statistische Klassifikation von Krankheiten

IHK:

Ischämische Herzkrankheit

IM:

Intermittierend

IRI:

Irinotecan

KI:

Kontinuierliche Infusion

Klin.:

Klinisch

KM:

Komorbiditäten

Komb.:

Kombinationstherapie

KRK:

Kolorektales Karzinom

KV:

Kardiovaskulär

KVE:

Kardiovaskuläre Erkrankung

KVTX:

Kardiovaskuläre Toxizität

LV(EF):

Linksventrikuläre (Ejektionsfraktion)

MD:

Median

Mono.:

Monotherapie

MMC:

Mitomycin

NB:

Nicht berichtet

OR:

Orale Gabe

OX:

Oxaliplatin

Pall.:

Palliativ

PE:

Pulmonaler Embolismus

Peri.:

Perioperativ

Pro.:

Prospektiv

Retro.:

Retrospektiv

rIL‑2:

Aldesleukin‑2

TVT:

Tiefe Venenthrombose

UFT:

Uracil + Tegafur

VTE:

Venöse Thromboembolie

WHO:

World Health Organization – Weltgesundheitsorganisation

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Funding

Förderung durch die Deutsche Krebshilfe (Fördernummer: 70112089)

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Authors and Affiliations

  1. Abteilung für Klinische Epidemiologie und Alternsforschung (C070), Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland

    Linda Weißer & Volker Arndt

  2. Medizinische Fakultät Heidelberg, Universität Heidelberg, Heidelberg, Deutschland

    Linda Weißer & Isabelle Finke

  3. Arbeitsgruppe – Cancer Survivorship (C071), Abteilung für Klinische Epidemiologie und Alternsforschung (C070), Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland

    Volker Arndt

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  1. Linda Weißer
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  2. Isabelle Finke
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Correspondence to Linda Weißer.

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Interessenkonflikt

L. Weißer, I. Finke und V. Arndt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Die Originalversion dieses Beitrags wurde korrigiert: In der zunächst Online veröffentlichten Version dieses Artikels fehlt die Angabe der Förderung durch die Deutsche Krebshilfe (Fördernummer: 70112089).

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Weißer, L., Finke, I. & Arndt, V. Kardiovaskuläre Spätfolgen der Chemotherapie bei Darmkrebspatienten. Onkologe 27, 724–738 (2021). https://doi.org/10.1007/s00761-021-00929-4

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