Terapia metronómica en el manejo del paciente veterinario con cáncer

María Lucía Suaréz, Rafaela Bortolotti Vièra, Annelise Carla Camplesi

Resumen


El cáncer es una problemática cada vez más frecuente en la práctica clínicade pequeños animales, para su control se emplean metodologías agresivascon múltiples efectos adversos, lo que ha estimulado la búsqueda denuevas estrategias terapéuticas. La quimioterapia metronómica consiste enla administración de bajas dosis de fármacos antineoplásicos, en intervalosregulares y por largos períodos de tiempo. Se destaca por su potencialantineoplásico, facilidad de administración y toxicidad reducida, mostrandobeneficio clínico en pacientes geriátricos, debilitados o con cáncer avanzado,logrado principalmente a través de la inhibición de la angiogénesis y lamodulación inmune antitumoral. En veterinaria, se relata principalmente eluso de ciclofosfamida, clorambucilo o lomustina, asociados en muchos casoscon otros fármacos, para el tratamiento de distintos tipos de tumores, con respuestas favorables y baja toxicidad. No obstante, los estudios existentes sonlimitados y en muchos casos la selección de la posología de administración de losfármacos ha sido empírica, perjudicando su eficacia terapéutica. El objetivo de esta revisiónes mostrar la utilidad de este tipo de quimioterapia antineoplásica en animalesdomésticos, los avances en la comprensión de sus mecanismos de acción, fármacos yesquemas utilizados, así como su potencial tóxico, buscando generar mayor concienciadel médico veterinario al utilizar esta modalidad de quimioterapia en pacientesoncológicos.

Abstract

Cancer is a frequent problem in veterinary practice in small animals; aggressive strategies with several side-effects are used to its control, which hasstimulated research of new therapeutic options. The metronomic chemotherapyconsists in regular administration of low doses of antineoplasticdrugs for long periods of time. Together with its antitumor potential, it isadministrated easily and has apparent reduced toxicity, showing clinicalbenefits within advanced diseases or geriatric and weak patients mainlyby angiogenesis inhibition and antitumor immune modulation. In smallanimals, cyclophosphamide, chlorambucil and lomustine have been usedmainly, in some cases associated with other drugs, to treat several kinds oftumors, obtaining clinical advantages and low toxicities. However, currentstudies are limited, and selection of most doses and intervals use to beempirical, in detriment of therapeutic efficacy. This work aims to evidencethe potential use of this kind of antineoplastic chemotherapy in domesticanimals, as well as the advances in comprehension of its mechanisms ofaction, drugs, schedules and toxic effects, trying to do a best and moreaware use of this chemotherapy strategy in oncologic patients.

Keywords: chemotherapy, dogs, low-dose, neoplasm, oncology.

Resumo

O câncer é um problema cada vez mais comum na rotina clínica de pequenos animais, epara seu controle são utilizadas metodologias agressivas com múltiplos efeitos adversos,o que estimula a busca de novas estratégias terapêuticas. A quimioterapia metronômicaconsiste na administração de baixas doses de drogas antineoplásicas, em intervalos regularese por longos períodos de tempo. Chama atenção devido ao por seu potencial antineoplásico,facilidade de administração e toxicidade reduzida, mostrando benefício clínicoem pacientes geriátricos, debilitados ou com câncer avançado, obtidos principalmente pormeio da inibição da angiogênese e da modulação imune antitumoral. Na medicina veterinária,o uso de ciclofosfamida, clorambucil ou lomustina, associado em muitos casos aoutras drogas, é relatado principalmente para o tratamento de diferentes tipos de tumores,com respostas favoráveis e baixa toxicidade. No entanto, os estudos existentes sãolimitados e, em muitos casos, a seleção da posologia da administração das drogas temsido empírica, prejudicando sua eficácia terapêutica. O objetivo desta revisão é mostrar autilidade deste tipo de quimioterapia antineoplásica em animais domésticos, os avançosna compreensão de seus mecanismos de ação, fármacos mais indicados e esquemas utilizados,bem como seu potencial tóxico, buscando gerar maior consciência do veterinárioao usar este tipo de quimioterapia em pacientes com câncer.

Palavras-chave: baixa dose, neoplasia, oncologia, cães, quimioterapia.


Palabras clave


chemotherapy, dogs, low-dose, neoplasm, oncology.

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