Влияние химиотерапии на васкуляризацию рака шейки матки

Стандартная химиотерапия подавляет ангиогенез и снижает васкуляризацию рака шейки матки (РШМ). Более выраженная реакция на лечение отмечена в сильнее васкуляризированных и оксигенированных опухолях, но из этого следует, что подавление ангиогенеза на начальных курсах химиотерапии может привести к снижению ответа при последующем лечении. Сохранение численной плотности сосудов во время терапии может служить в качестве прогностического фактора недостаточно хорошего ответа на лечение. Методы молекулярной таргетной терапии РШМ направлены, в первую очередь, на ингибирование ангиогенеза и восстановление нормального функционирования иммунной системы, борющейся с опухолью. Добавление препаратов таргетной антиангиогенной терапии к стандартным цитостатическим средствам для лечения пациентов с персистирующим, рецидивирующим или метастатическим РШМ увеличивает выживаемость без прогрессирования и общий срок жизни, но побочные эффекты такой терапии часто бывают тяжёлыми, а иногда и фатальными. В качестве основных осложнений зарегистрированы нейтропении, центральные и периферические артериальные и венозные тромбозы, формирование кишечных и влагалищных свищей. Очень быстро развивается устойчивость к таргетным препаратам с последующим восстановлением и даже нарастанием васкуляризации вследствие прогрессирования гипоксии опухолевых клеток и включения путей ангиогенеза без участия VEGF. Следует обратить внимание, что подавление ангиогенеза в процессе любого метода лечения РШМ усиливает гипоксию оставшейся опухоли, что способствует усилению продукции и выброса проангиогенных цитокинов, таких как VEGF, и прогрессированию ангиогенеза.

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