Вторые первичные опухоли у онкологических больных: лекарственный канцерогенез в онкологии

Цитостатики, используемые в химиотерапии, вызывают образование вторых первичных опухолей у некоторых больных, излеченных от первого новообразования. При этом риск возникновения вторых опухолей после излечения от первых повышается в 4–6 раз по сравнению с общей популяцией. В обзоре приведены современные данные о механизме злокачественной трансформации клеток цитостатиками, группах повышенного риска, связанного с врожденным полиморфизмом систем метаболизма ксенобиотиков и репарацией повреждений ДНК. Наибольший риск лекарственных опухолей отмечен у пациентов с высокой активностью изоформ цитохрома Р450, превращающего транспортные формы цитостатиков в активные электрофильные метаболиты, и с низким уровнем детоксицирующих ферментов. При прочих равных условиях в группу повышенного риска входят больные с низкой активностью ферментов репарации ДНК. Рассматриваются возможности исследования канцерогенного потенциала новых таргетных препаратов в эксперименте в целях минимизации риска возникновения вторых опухолей, обусловленных лечением.

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