Le linee guida per prevenire, monitorare e trattare la cardiotossicità. Uno studio fa luce sui meccanismi responsabili
MILANO – Uno studio comparso sulla rivista Nature Medicine fa luce su un meccanismo molecolare per cui un farmaco chemioterapico può causare problemi cardiaci. Il farmaco studiato dai ricercatori è la doxorubicina, da 50 anni utilizzata per curare molti tipi di cancro. «La tossicità cardiovascolare è una potenziale complicazione di diverse terapie anticancro ed è un argomento che richiama crescente attenzione – spiega Daniela Cardinale, direttore dell’Unità di cardioncologia all’Istituto europeo di oncologia di Milano -. Non a caso proprio nei giorni scorsi sono state pubblicate su Annals of Oncology le linee guida pratiche della Società europea in oncologia (Esmo) sulla cardiotossicità indotta sia da chemio e radioterapia che dalle nuove target therapy».
ALLEANZA TRA ONCOLOGI E CARDIOLOGI – Grazie al numero crescente di pazienti che guarisce o che convive a lungo con il tumore, è possibile oggi analizzare anche gli effetti a lungo termine delle cure. Sono così sempre più numerose le ricerche che provano come alcuni chemioterapici (ad esempio le antracicline) e alcuni farmaci a bersaglio molecolare (generalmente considerati meno tossici) siano potenzialmente responsabili di disfunzioni cardiache e conseguenze indesiderate a livello cardiovascolare, talvolta irreversibili. «Le linee guida Esmo – aggiunge Cardinale – servono quindi a prevenire, monitorare e trattare i possibili danni al cuore dei trattamenti anticancro. In pratica è fondamentale che i pazienti oncologici siano tenuti sotto una particolare osservazione cardiologica: oggi esistono gli strumenti per individuare precocemente, prima di un effettivo danno cardiaco, la cardiotossicità da chemio. E in molti casi è anche possibile fermarla o curarla anche se già presente. Serve una stretta collaborazione tra oncologi e cardiologi, anche perché, secondo le statistiche, circa la metà dei malati di tumore ha anche (del tutto indipendente dal cancro) un problema cardiovascolare».
LO STUDIO – Nello studio pubblicato su Nature Medicine i ricercatori dell’MD Anderson Cancer Center della University of Texas rivelano di aver scoperto un inatteso meccanismo molecolare che, attraverso l’enzima Top2b, potrebbe portare la doxorubicina ad attaccare il cuore, causando un aumento nello stress ossidativo che danneggia i tessuti muscolari cardiaci. Gli esiti dello studio potrebbe fornire un nuovo approccio per identificare quei pazienti più a rischio di cardiotossicità e quelli che invece possono tollerare con sicurezza il «vecchio» chemioterapico tuttora molto efficace per lo più in combinazione con altri farmaci nella cura di tumori di seno, polmone, ovaio, vescica e contro leucemie e linfomi. «Da alcuni, insieme ai colleghi americani dell’Anderson Cancer Center e della Vanderbilt University di Nashville anche noi dello Ieo abbiamo condotto ricerche a livello traslazionale per cercare nella cellula, in fase preclinica, dei biomarker di cardiotossicità e dei meccanismi che ne sono responsabili – commenta Carlo Cipolla, Direttore della Divisione di Cardiologia Ieo -. L’obiettivo è quello di scoprire, fra i vari trattamenti anticancro, i diversi responsabili dei danni al cuore per poter creare nuovi farmaci antitumorali che non siano potenzialmente cardiotossici».
CONSIGLI AI PAZIENTI – Mentre le ricerche procedono, c’è però qualcosa che anche i pazienti possono fare fin da subito. «Sono consigli validi per tutti – conclude Cipolla, che è anche presidente della International Cardioncology Society per Europa e Asia -, ma soprattutto dopo le terapie oncologiche è fondamentale, per salvaguardare la salute cardiovascolare, resettare fisiologicamente il proprio stile di vita e in particolare evitare fumo, sovrappeso e i picchi di insulina (in particolare i dolci e più di un alimento ricco di carboidrati per pasto). Inoltre bisogna fare continuativamente un’attività fisica di impegno medio-basso, aerobica, armonica, di rilassamento più che di allenamento (come lunghe camminale, cyclette o stepper con poco carico, sport aerobici come nuoto e golf). Infine, sarebbe bene fare almeno una visita cardiologica semestrale nei primi due anni dopo chemioterapia».
Fonte: “corriere.it” – 30 novembre 2012
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