Despite the known cardiotoxic effects of doxorubicin and other anthracyclines, no evidence-based guidelines exist for the surveillance and prevention of chemotherapy-induced cardiotoxicity in adult survivors of breast cancer who have had limited previous doses of anthracyclines (ie, total cumulative dose 240 mg/m²), or limited-dose anthracyclines followed by trastuzumab-based regimens. Nonetheless, some national and international cardio-oncology and cardiac-imaging organisations recommend increased cardiac surveillance during or after treatment, measurement of cardiac biomarkers and other surrogate endpoints, and in some cases initiation of cardioprotective drug therapy in asymptomatic women. However, two unintended potential harms of such approaches are medicalisation (definition and treatment of subclinical heart problems without high-level evidence for a consequent reduction in the incidence of subsequent heart failure or cardiac deaths) and increased health-care costs when the value of providing that care is unknown. Whether existing cardio-oncology or imaging guideline recommendations will provide increased value or cause increased distress and lower health-related quality of life is unknown. Further research is needed to assess the long-term benefits, harms, and value of expanded cardiac surveillance, use of surrogate cardiac biomarkers, and prophylactic cardioprotective therapy in asymptomatic women with limited exposure to anthracyclines.

中文翻译：

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蒽环类药物治疗的心脏毒性作用：证据是什么，潜在的危害是什么？

尽管已知阿霉素和其他蒽环类药物具有心脏毒性作用，但尚无循证医学指南来监测和预防先前蒽环类药物剂量有限的成年乳腺癌成年幸存者的化学诱导的心脏毒性（即总累积剂量240 mg / ²米）或有限剂量的蒽环类药物，然后接受基于曲妥珠单抗的治疗方案。但是，一些国家和国际心脏肿瘤和心脏成像组织建议在治疗期间或之后加强心脏监护，测量心脏生物标志物和其他替代终点，并在某些情况下开始对无症状女性进行心脏保护性药物治疗。但是，这种方法有两个意想不到的潜在危害：医疗（定义和治疗亚临床心脏问题，而没有高水平的证据证明随后减少了随后的心力衰竭或心源性死亡的发生率），当提供医疗服务时，医疗成本增加了。这种护理是未知的。现有的心血管肿瘤学或影像学指南建议是否会提供更高的价值或引起更大的困扰，并降低与健康相关的生活质量，这一点尚不得而知。需要进一步的研究来评估扩大的心脏监护，替代心脏生物标志物的使用以及对蒽环类药物有限接触的无症状女性的预防性心脏保护治疗的长期益处，危害和价值。