Farmacoterapia personalizada en oncología: Aplicación de criterios farmacocinéticos-farmacodinámicos
Resumen
Objetivo: La indicación de una farmacoterapia personalizada en oncología se sustenta en la selección del tratamiento óptimo (fármacos, dosis, vías y métodos de administración y duración) y en el método de ajuste de la dosis para alcanzar la máxima eficacia antineoplásica, expresada en términos de remisión de la enfermedad o de tiempo libre de recaída, con una toxicidad aceptable para el paciente. El objetivo de este trabajo es explorar la contribución, en la personalización terapéutica en oncología clínica asistencial, de la monitorización terapéutica de las concentraciones plasmáticas y la aplicación de la información farmacocinética y farmacodinámica disponible para algunos fármacos ampliamente utilizados.
Método: Se ha realizado una revisión bibliográfica no sistemática completa de los criterios farmacocinéticos y farmacodinámicos de los antineoplásicos, así como de los resultados derivados de su utilización en la práctica clínica asistencial. En la búsqueda de artículos de alta calidad sobre los temas planteados se han incluido fuentes bibliográficas primarias y secundarias. La tilidad de la monitorización terapéutica se ha centrado en fármacos citotóxicos parenterales, antineoplásicos orales, anticuerpos monoclonales y otras terapias biológicas utilizadas en la práctica clínica asistencial.
Resultados: La personalización terapéutica de fármacos antineoplásicos basada en la monitorización terapéutica de las oncentraciones plasmáticas, y la información que proporcionan los modelos farmacocinéticos- farmacodinámicos, permite reducir la toxicidad y aumentar la efectividad asociada al tratamiento. Cuando se instaura un tratamiento personalizado con metotrexato a altas dosis en pacientes con osteosarcoma se alcanza la concentración máxima objetivo en un 70% de los ciclos (49% en dosis fijas), y con 5-fluorouracilo en pacientes con cáncer colorrectal la tasa de respuesta es del 33,7% (18,3% en dosis fijas). Con asparaginasa, busulfán, antineoplásicos orales y anticuerpos monoclonales se obtienen tasas de beneficios similares.
Conclusiones: Debido al bajo intervalo terapéutico de los medicamentos antineoplásicos y a su alta variabilidad en la respuesta clínica, tanto en términos de efectividad como de seguridad, la monitorización de sus concentraciones plasmáticas, y la aplicación de los principios y de los modelos farmacocinéticos y farmacodinámicos, constituyen herramientas actibles y prometedoras en la personalización de los tratamientos en oncología.
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