Кардиотоксичность противоопухолевой химиотерапии и возможные терапевтические подходы

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.

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