Mecanismos de acción de la cardiotoxicidad inducida por terapias anti-neoplásicas

Daniel Carballo Torres; Jorge Luis Soriano García; Manuel Bazán Milián

Mecanismos de acción de la cardiotoxicidad inducida por terapias anti-neoplásicas

Daniel Carballo Torres, Jorge Luis Soriano García, Manuel Bazán Milián

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Resumen

Introducción: La cardiotoxicidad relacionada con las terapias del cáncer sigue siendo un desafío importante para cardiólogos y oncólogos.

Objetivo: Identificar los diferentes mecanismos de acción por el cual las terapias antineoplásicas inducen una cardiotoxicidad en los pacientes oncológicos.

Métodos: Se realizó una búsqueda en base de datos PubMed, de artículos en inglés y español, en los últimos diez años, con los descriptores: "cardiotoxicity", "treatment", "cancer" y "action mechanisms" combinadas mediante los operadores lógicos: “and” y “or”.

Desarrollo: El sistema cardiovascular parece ser muy sensible a la acción de muchos fármacos anti-neoplásicos, que pueden causar eventos tromboembólicos, isquemia, hipertensión arterial, arritmia y disfunción ventricular izquierda, que conduce a la insuficiencia cardíaca. Las antraciclinas son los fármacos cardiotóxicos más estudiados. El incremento en el uso de nuevos fármacos biológicos, agregan otros mecanismos de cardiotoxicidad secundarios. Losinhibidores de señalización intracelular como los inhibidores de tirosin-quinasas afectan el sistema cardiovascular al bloquear las vías principales de función del miocardio, especialmente en condiciones de estrés cardíaco, como hipertensión o hipertrofia. La falta de monitorizajes de rutina de eventos cardíacos en ensayos de inmunoterapia probablemente ha contribuido al subregistro de cardiotoxicidades inducidas por los inhibidores de puntos de control.

Conclusiones: El mayor y mejor conocimiento de los diferentes mecanismos de cardiotoxicidad secundarios a tratamientos antineoplásicos ha permitido entender las alteraciones sobre el sistema cardiovascular e implementar pautas de administración menos nocivas.

Palabras clave: cardiotoxicidad; tratamiento para cáncer; mecanismo de acción.

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