medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-141medsovet-9124Research ArticleКОМОРБИДНЫЙ ПАЦИЕНТCOMORBID PATIENTКардиотоксичность противоопухолевой химиотерапии и возможные терапевтические подходыCardiotoxicity of anticancer chemotherapy and possible therapeutic approachesГасановИ. И.GasanowI. I.

Гасанов Илкин Игбал-оглы, врач-кардиолог

125130, Россия, Москва, Старопетровский проезд, д. 7а, стр. 22 

Ilkin I. Gasanow, Cardiologist

7a, Bldg. 22, Staropetrovsky Proezd, Moscow, 125130, Russia

gasanowilkind@yandex.ruТемирсултановаТ. Х.TemirsyltanovaT. Kh.

Темирсултанова Тамара Хамзатовна, к.м.н., врач-кардиолог

125130, Россия, Москва, Старопетровский проезд, д. 7а, стр. 22

Tamara Kh. Temirsyltanova, Cand. Sci. (Med.), Cardiologist

7a, Bldg. 22, Staropetrovsky Proezd, Moscow, 125130, Russia

temirsyltanova@rambler.ruДэрайс – СМ-клиникаРоссияDERAIS – SM-ClinicRussian Federation20252405202506201213Copyright © Гасанов И.И., Темирсултанова Т.Х., 20252025Гасанов И.И., Темирсултанова Т.Х.Gasanow I.I., Temirsyltanova T.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9124

В наши дни достигнуты большие успехи в лечении онкологических больных. Перманентно разрабатываются новые медицинские технологии и новые методы лечения. Наблюдается увеличение пятилетней выживаемости для большинства видов рака. Однако вместе с этими успехами возникала проблема, обусловленная кардиотоксичностью химиотерапевтических препаратов. В настоящее время точные механизмы развития кардиоваскулотоксичности при применении химиотерапевтических препаратов не известны. Существует довольно много гипотез, пытающихся объяснить данный патологический феномен. Принципиально можно выделить два механизма развития кардиотоксичности: первый обусловлен нарушением, модификацией процессов репликации, транскрипции ДНК. Второй же обусловлен избыточным образованием активных форм кислорода, истощением антиоксидантной системы, индукцией перекисного окисления липидов, ведущих к повреждению сарколеммы, развитию дисфункции митохондрий и нарушению процессов окислительного фосфорилирования. Имеется большое количество лекарственных препаратов, способных предупредить кардиотоксичность, но их эффекты варьируют и находятся в зависимости от многих факторов. В данной статье была сделана попытка обобщить патофизиологические механизмы кардиоваскулотоксичности, ассоциированные с применением химиотерапевтических препаратов. Подробно рассмотрены механизмы антрациклин-индуцированной кардиотоксичности, а также потенциальные терапевтические стратегии ее профилактики и лечения. Имеется отчетливая связь между разработкой теоретических основ и их прикладным применением. Совершенствуются методы диагностики, которые уже сегодня позволяют на ранних стадиях выявлять кардиотоксичность. Однако, несмотря на успехи в области диагностики, профилактика и лечение кардиотоксичности остается «темной материей» кардиоонкологии.

Nowadays great advances have been achieved in the treatment of cancer patients. New medical technology, new treatment methods are constantly being developed. Increase in 5 year survival rate is being witnessed for most types of cancer. However along with this success, in parallel to it, another problem is observed, which is induced by the cardiotoxicity of chemotherapeutic drugs. Currently the exact mechanisms behind the cardiovascular toxicity associated with the use of the chemotherapeutic drugs are unknown. There are quite a few hypotheses trying to explain this pathological phenomenon. Fundamentally two mechanisms for the development of cardiotoxicity can be distinguished. The first mechanism is due to disruption and modification of the DNA replication and transcription processes. The second mechanism is caused by excessive formation of reactive oxygen species, depletion of the antioxidant system, induction of lipid peroxidation, leading to damage of the sarcolemma and the development of mitochondrial dysfunction, which in turn causes disruption of the oxidative phosphorylation processes. There are a large number of drugs available to prevent cardiotoxicity, but their effects vary and depend on many factors. This article attempts to summarize the pathophysiological mechanisms of cardiotoxicity associated with the use of chemotherapeutic drugs. The mechanisms of anthracycline-induced cardiotoxicity, as well as potential therapeutic strategies for its prevention and treatment, are reviewed in detail. There is a clear connection between the development of theoretical foundations and their practical application. Nowadays the diagnostic methods are being improved, which make it possible to detect cardiotoxicity in the early stages. However, despite the advances in the field of diagnostics, prevention and treatment of cardiotoxicity remain as the “dark matter” of cardio-oncology.

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