Anthracycline 類化療藥物引起的心臟毒性概論

1 101 98 10 1 Anthracycline Anthracyclines Anthracyclines DNA DNA Polymerases DNA RNA Anthracyclines Anthracyclines doxorubicin Fe-dependent Fe-independent doxorubicin (Oxidative stress) ROS(Reactive oxygen species) 1. [6] doxorubicin 400 550 700 mg/m2 3% 7% 18% [3] doxorubicin 550 600 600 mg/m2 4% 18% 36% doxorubicin 550 mg/m2 Epirubicin 900 mg/m2[4] Anthracyclines Anthracyclines Anthracyclines 2.

2 IV bolus IV bolus 3. 101 98 10 2 Anthracycline Anthracycline 4. Mediastinal irradiation Anthracycline Anthracyclines 5. Anthracyclines Cyclophosphamide Paclitaxel Docetaxel Trastuzumab 6. Cyclophosphamide Mediastinal irradiation Anthracyclines Anthracyclines 1.

3 doxorubicin doxorubicin Epirubicin Idarubicin Mitoxantrone Epirubicin mg doxorubicin Epirubicin 900 mg/m2 Epirubicin doxorubicin Epirubicin Idarubicin Anthracyclines (Congestive heart failure CHF) doxorubicin > Epirubicin> Idarubicin Idarubicin 150mg/m2[4] Mitoxantrone Anthraquinone Anthracyclines Mitoxantrone 140 mg/m2[4] doxorubicin (Liposome) doxorubicin 500 mg/m2 101 98 10 3 doxorubicin doxorubicin 2.

4 DexrazoxaneDexrazoxane Anthracycline Dexrazoxane EDTA Anthracyclines Dexrazoxane Anthracyclines Dexrazoxane doxorubicin 300 mg/m2 Dexrazoxane Dexrazoxane doxorubicin 10 1 50 mg/m2 doxorubicin 500 mg/m2 Dexrazoxane Dexrazoxane doxorubicin Dexrazoxane 30 ( 40 ml/min) Dexrazoxane doxorubicin 5 1 doxorubicin Dexrazoxane doxorubicin 10 1 ASCO Dexrazoxane doxorubicin doxorubicin 300mg/m2 Dexrazoxane doxorubicin 300mg/m2 Dexrazoxane Anthracyclines Anthracyclines (Afterload) (Angiotensin converting enzyme inhibitor ACEI ) (Diogxin ) Carvedilol(Beta blocker) Anthracyclines LVEF(Left ventricularejection fraction)

5 doxorubicin 100 mg/m2 doxorubicin 101 98 10 4 (Radionuclide Angiocardiography) LVEF LVEF 1. Baseline LVEF ( 50%) 250~300 mg/m2 400 mg/m2 EKG Cyclophosphamide 450 mg/m2 2. Baseline LVEF ( 50%) LVEF 30% doxorubicin LVEF 30%~50% LVEF 10% 30% doxorubicin 1991 doxorubicin Anthracyclines Dexrazoxane Anthracyclines ASCO Dexrazoxane ACEI Anthracyclines -Dexrazoxane- Anthracyclines Anthracyclines Anthracyclines

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8 J Clin Oncol. 2002 Mar 15;20(6) Chronic progressive cardiac dysfunction years after doxorubicin therapy forchildhood acute lymphoblastic leukemia. Lipshultz SE; Lipsitz SR; Sallan SE;Dalton VM; Mone SM; Gelber RD; Colan SD. J Clin Oncol 2005 Apr20;23(12) Cardiac abnormalities 15 years and more after adriamycin therapy in 229childhood survivors of a solid tumour at the Institut Gustave Roussy. Pein F;Sakiroglu O; Dahan M; Lebidois J; Merlet P; Shamsaldin A; Villain E; deVathaire F; Sidi D; Hartmann O. Br J Cancer2004 Jul 5;91(1) Noninvasive evaluation of late Anthracycline cardiac toxicity in childhood cancersurvivors. Hudson MM; Rai SN; Nunez C; Merchant TE; Marina NM; Zalamea N;Cox C; Phipps S; Pompeu R; Rosenthal D.

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