safetyriskБезопасность и риск фармакотерапииSafety and Risk of Pharmacotherapy2312-78212619-1164Federal State Budgetary Institution ‘Scientific Centre for Expert Evaluation of Medicinal Products’ of the Ministry of Health of the Russian Federation (FSBI ‘SCEEMP’)10.30895/2312-7821-2020-8-4-178-190safetyrisk-200Research ArticleОБЗОРЫREVIEWSЛекарственно-индуцированная фибрилляция предсердий, ассоциированная с применением противоопухолевых лекарственных средствAtrial Fibrillation Associated with Anticancer Drugshttps://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

Остроумова Ольга Дмитриевна, доктор медицинских наук, профессор.ул. Баррикадная, д. 2/1, стр. 1, Москва, 125993

Olga D. Ostroumova, Dr. Sci. (Med.), Professor.2/1/1 Barrikadnaya St., Moscow 125993

ostroumova.olga@mail.ruhttps://orcid.org/0000-0003-3091-7904ЧерняеваМ. С.ChernyaevaM. S.

Черняева Марина Сергеевна, кандидат медицинских наук, доцент.ул. Маршала Тимошенко, д. 19, стр. 1А, Москва, 121359; Волгоградский проспект, д. 168, Москва, 109472

Marina S. Chernyaeva, Cand. Sci. (Med.), Associate Professor.19/1A Marshal Timoshenko St., Moscow 121359; 168 Volgogradsky Ave., Moscow 109472

Pilya.ru@mail.ruhttps://orcid.org/0000-0001-5801-3742КочетковА. И.KochetkovA. I.

Кочетков Алексей Иванович, кандидат медицинских наук.ул. Баррикадная, д. 2/1, стр. 1, Москва, 125993

Aleksey I. Kochetkov, Cand. Sci. (Med.).2/1/1 Barrikadnaya St., Moscow 125993

ak_info@list.ruhttps://orcid.org/0000-0003-4434-9311БахтееваД. И.BakhteevaD. I.

Бахтеева Дамира Исхаковна.ул. Баррикадная, д. 2/1, стр. 1, Москва, 125993

Damira I. Bakhteeva.2/1/1 Barrikadnaya St., Moscow 125993

bdamirya1994@mail.ruhttps://orcid.org/0000-0001-6700-0214ИвановС. Н.IvanovS. N.

Иванов Сергей Николаевич, кандидат медицинских наук, доцент.Волгоградский проспект, д. 168, Москва, 109472; ул. Островитянова, д. 1, Москва, 117997

Sergei N. Ivanov, Cand. Sci. (Med.), Associate Professor.168 Volgogradsky Ave., Moscow 109472; 1 Ostrovityanova St., Moscow 117997

snivanov@mail.ruhttps://orcid.org/0000-0002-4496-3680СычевД. А.SychevD. A.

Сычев Дмитрий Алексеевич, доктор медицинских наук, профессор, член-корреспондент РАН.ул. Баррикадная, д. 2/1, стр. 1, Москва, 125993

Dmitry A. Sychev, Dr. Sci. (Med.), Professor, Corresponding Member RAS.2/1/1 Barrikadnaya St., Moscow 125993

dmitry.alex.sychev@gmail.comРоссийская медицинская академия непрерывного профессионального образования Министерства здравоохранения Российской ФедерацииРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationЦентральная государственная медицинская академия Управления делами Президента Российской Федерации; Госпиталь для ветеранов войн № 2 Департамента здравоохранения города МосквыРоссияCentral State Medical Academy of Department of Presidential Affairs, Hospital for War Veterans No. 2 of the Moscow City Health DepartmentRussian FederationГоспиталь для ветеранов войн № 2 Департамента здравоохранения города Москвы; Российский национальный исследовательский медицинский университет имени Н.И. Пирогова Министерства здравоохранения Российской ФедерацииРоссияHospital for War Veterans No. 2 of the Moscow City Health Department; Pirogov Russian National Research Medical UniversityRussian Federation20200212202084178190Copyright © Остроумова О.Д., Черняева М.С., Кочетков А.И., Бахтеева Д.И., Иванов С.Н., Сычев Д.А., 20202020Остроумова О.Д., Черняева М.С., Кочетков А.И., Бахтеева Д.И., Иванов С.Н., Сычев Д.А.Ostroumova O.D., Chernyaeva M.S., Kochetkov A.I., Bakhteeva D.I., Ivanov S.N., Sychev D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.risksafety.ru/jour/article/view/200

Фибрилляция предсердий является серьезной нежелательной реакцией на фоне лечения противоопухолевыми лекарственными средствами. Цель работы: анализ данных научной литературы о распространенности, патофизиологических механизмах, факторах риска фибрилляции предсердий, ассоциированной с применением противоопухолевых лекарственных средств, ее профилактике и лечении. В результате проведенного исследования было выявлено, что частота встречаемости лекарственно-индуцированной фибрилляции предсердий варьирует в зависимости от конкретного противоопухолевого лекарственного средства и составляет от 1 до 86%. Ее развитие ассоциировано с применением противоопухолевых средств растительного происхождения, алкилирующих средств, ингибиторов протеинкиназ, моноклональных антител, иммунодепрессантов, противоопухолевых антибиотиков, антиметаболитов, противоопухолевых гормональных средств, антагонистов гормонов и др. Наиболее часто фибрилляция предсердий возникает на фоне применения таких препаратов, как гемцитабин (в сочетании с винорелбином), цисплатин, мелфалан, ибрутиниб, цетуксимаб, трастузумаб, алемтузумаб и доксорубицин. Показано, что патофизиологические механизмы, лежащие в основе развития фибрилляции предсердий при применении противоопухолевых препаратов, включают электрофизиологические нарушения, повреждение миокарда, воспаление, иммунный ответ, апоптоз и оксидативный стресс. Факторы риска развития лекарственно-индуцированной фибрилляции предсердий на фоне терапии противоопухолевыми лекарственными средствами в настоящее время четко не определены и продолжают изучаться. Для предотвращения развития лекарственно-индуцированной фибрилляции предсердий при ведении онкологических пациентов крайне важен мультидисциплинарный подход с участием онкогематолога и кардиолога, а также настороженность врачей в отношении возможности развития такой нежелательной реакции.

Atrial fibrillation is a serious adverse reaction associated with the use of anticancer drugs. The aim of the study was to analyse scientific literature on the prevalence, pathophysiological mechanisms, and risk factors of anticancer drug-induced atrial fibrillation, ways of its prevention and treatment. The results of the study showed that the incidence of drug-induced atrial fibrillation varies depending on a specific anticancer drug and ranges from 1 to 86%. It is associated with the use of herbal anticancer agents, alkylating agents, protein kinase inhibitors, monoclonal antibodies, immunosuppressants, antitumor antibiotics, antimetabolites, hormonal anticancer agents, hormone antagonists, etc. Most often, atrial fibrillation develops following the use of such drugs as gemcitabine (in combination with vinorelbine), cisplatin, melphalan, ibrutinib, cetuximab, trastuzumab, alemtuzumab, and doxorubicin. It was demonstrated that the pathophysiological mechanisms underlying the development of atrial fibrillation induced by anticancer drugs include electrophysiological abnormalities, myocardial injury, inflammation, immune response, apoptosis, and oxidative stress. Risk factors for the development of anticancer drug-induced atrial fibrillation are not clearly defined yet and continue to be the subject of research. Prevention of drug-induced atrial fibrillation in cancer patients requires a multidisciplinary approach involving participation of an oncohematologist and a cardiologist. The doctors in charge should also be vigilant regarding potential development of this adverse reaction.

 

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The authors declare that there are no conflicts of interest present.