Sponsored by Dalian Heart Society, Cardiovascular Disease Branch (CSC) of Chinese Medical Association, Expert Committee of Oncology and Cardiology of Chinese Society of Clinical Oncology (CSCO), Integrated Oncology Branch of Chinese Anti-Cancer Association (CACA), Oncology And Cardiology Professional Committee of Cardiovascular Physicians Branch of Chinese Medical Doctor Association, Oncology Cardiology Group of Cardiovascular Disease Professional Committee of Chinese Association of Integrative Traditional and Western Medicine, Tumor Cardiology Professional Committee of Gerontology and Geriatrics Association Geriatrics Branch, The 6th China Conference on Oncology and Cardiology (CCOC) in 2021, hosted by the First Affiliated Hospital of Dalian Medical University and co-organized by The Third Degree Medicine and Liangyihui, was held online on the morning of December 31, 2021.
During this meeting, Professor Xiao Xiuying of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine was invited to give a keynote speech on "Management of Cardiotoxicity of Antitumor Drugs".
Xiao Xiuying
Doctor of Oncology, Chief Physician, Master Supervisor
Deputy Director of the Department of Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine
Member of the Stomach Cancer Professional Committee of the CSCO
Member and Secretary of oncology Branch of Shanghai Medical Association
Youth Director of Shanghai Anti-Cancer Association
He is a young member of the Gastrointestinal Tumor Professional Committee of the Chinese Association of Research Hospitals
Member of the Thoracic Tumor Professional Committee of the China Medical Education Association
Member of the Tumor Immunotherapy Professional Committee of Shanghai Anti-Cancer Association
Member of the Gastric Cancer Molecular Targeting and Immunotherapy Professional Committee of Shanghai Anti-Cancer Association
Member of the Palliative Care Committee of Shanghai Anti-Cancer Association
Member of the Traditional Medicine Committee of Shanghai Anti-Cancer Association
Member of the Lung Cancer Professional Committee of Shanghai Association of Women Physicians
Professor Xiao first pointed out that both tumors and cardiovascular diseases have the characteristics of large base and rapid growth. Moreover, in the diagnosis and treatment of tumors, there are not a few patients with cardiovascular system-related complications, tumor cardiology has become a hot spot in recent research, anti-tumor drugs in killing tumor cells at the same time, but also cause adverse reactions, different anti-tumor drugs caused by cardiotoxicity incidence is also different.
Professor Xiao then elaborated on the mechanism, characteristics, monitoring, prevention and treatment of cardiotoxicity caused by anthracycline, fluorouracil, targeted and immunotherapy drugs. Taking fluorouracil drugs as an example, fluorouracil drugs are metabolized by DPD enzyme and the product fluoroxic acid inhibits the citric acid cycle, resulting in reduced ATP production and apoptosis of cardiomyocytes, thus triggering cardiotoxicity.
According to a "fluorouracil cardiotoxicity study in Chinese populations", the overall incidence of cardiotoxic events of fluorouracil drugs was 30.6%, of which the incidence of cardiotoxic events caused by 5-FU was 25%, and the incidence of cardiotoxic events caused by capecitabine was 33.84%. Therefore, close monitoring and long-term follow-up are required during and after fluorouracil treatment.
In addition, studies have shown that the risk of cardiotoxicity is significantly increased in the use of fluorouracils in patients with a history of previous heart disease, and the prophylactic use of nitrates and CCBs may not be effective, so pyrimidine analogues are not recommended for patients with a history of previous heart disease. Raltetrexed, as a non-fluorouracil drug, does not lead to the accumulation of related metabolites, thereby avoiding the occurrence of cardiotoxicity, and raltetrexed is a safe alternative to fluorouracil in patients with a previous history of CVD or advanced colorectal cancer with a high risk factor of CV.
Finally, Professor Xiao called for the need to manage the cardiotoxicity of anti-tumor drugs. Before treatment, it is necessary to have a certain prejudgment of the incidence of cardiotoxicity of related drugs, pay attention to high-risk groups, and do a good job of rigorous testing; during treatment, when cardiotoxicity occurs, it is necessary to accurately diagnose and assess the severity, grasp the timing of the use of symptomatic/replacement drugs or the reduction cycle of the original drug; after treatment, pay attention to the safety and necessity of the reuse of related drugs.
With the aim of "based on clinical, based on practice, Chinese and Western discourse, collaborative innovation", adhering to the concept of "inheritance, innovation, wisdom and development", the conference linked the main venue of Dalian and 11 sub-venues in different regions, bringing together well-known experts and scholars at home and abroad in cardiovascular diseases, oncology, hematology, medical imaging, clinical pharmacy and other disciplines, aiming to build a platform for oncology cardiology workers to display and communicate, focusing on dynamic real-time monitoring of myocardial injury, flexible adjustment of diagnosis and treatment strategies, etc. Improve the heart health level of cancer patients, promote academic exchanges and related consensus in the industry, and further promote the vigorous development of oncology cardiology in China.