Pot pacientele cu cancer mamar sa ia statine?

  1. nutritie oncologica statine cancer mama

Dupa intervenție chirurgicala ± chimioterapie si radioterapie, pacientele cu cancer mamar ER+ incep tratamentul antiestrogenic. Ca efect secundar al tratamentului antiestrogenic sau ca efect secundar stilului de alimentatie si sedentarismului, unele paciente cu cancer mamar prezinta dislipidemie tratabila cu statine.

 

Printre altele, unele dintre principalele efecte secundare ale medicamentelor antiestrogenice sunt durerile musculare si articulare. Si, printre altele, unele dintre principalele efecte secundare ale statinelor sunt durerile musculare si articulare. Asa ca – cel putin deoarece prezinta acelas impact muscular nociv care poate fi amplificat ca si intesitate si impact clinic in caz de administrare concomitenta – este justificata intrebarea:

 

– Pot pacientele cu cancer mamar ER+ sa ia statine pe parcursul tratamentului antiestrogenic?

 

Insa, haideti sa incepem cu o intrebare mult mai importanta:

 

– Pot pacientele cu cancer mamar sa ia statine?

 

Desigur, de putut oricine poate lua o pastila – sensul celei de-a doua intrebari de mai sus referindu-se la carcinogenitatea statinelor si la impactul administrarii acestor medicamente asupra riscului de mortalitate al pacientelor cu cancer mamar.

 

Administrarea de statine nu este asociata epidemiologic cu cresterea riscului de cancer – Browning si Martin, 2007. Dar, studiile randomizate controlat care sa analizeze riscurile coadminstrarii de statine in cazul pacientelor cu cancer mamar lipsesc.

 

Tot ce avem sunt o multitudine de studii epidemiologice cu rezultate care se bat direct cap in cap:

 

– administrarea de statine in cazul persoanelor fara cancer:

 

 

– administrarea de statine in cazul pacientelor cu cancer mamar:

 

 

Cu toate astea, cercetatorii care au realizat analiza sistematica a acestor multe studii epidemiologice sustin ca pacientele cu cancer mamar care iau statine aparent au un prognostic mai bun. (Manthravadi, Shrestha si Madhusudhana, 2016)

 

Deci unu: studiile epidemiologice – pe romaneste studiile care nu stabilesc relatii de cauzalitate, ci doar indica posibili factori de risc care trebuie evaluati in studii randomizate controlat – sustin ipoteza ca in general administrarea de statine pare sigura din punct de vedere oncologic, cu toate ca momentan nu stim daca este asa sau nu.

 

Si – desi statinele reprezinta practic tipul de medicament cel mai vandut de pe planeta – in mod paradoxal analiza sistematica realizata de Ravnskov si colab. in 2016 sustine ca persoanele peste 60 de ani cu nivel crescut de LDL colesterol au o durata de supravietuire mai mare decat cele cu nivele scazute de LDL colesterol.

 

Deci doi: faptul ca scaderea colesterolului prin administrarea de statine are impact clinic benefic este o generalizare nu o certitudine.

 

Insa, stim ca administrarea statinelor asociaza ca efect secundar principale cauze ale obezitatii:

 

 

Deci trei: administrarea de statine este implicata in cresterea riscului de obezitate sarcopenica.

 

Iar obezitatea pacientelor cu cancer mamar creste riscul de metastaze, recidiva si mortalitate.

 

Studii citate:

 

Aiman, U., Najmi, A., & Khan, R. A. (2014). Statin induced diabetes and its clinical implications. Journal of pharmacology & pharmacotherapeutics5(3), 181.

 

Browning, D. R., & Martin, R. M. (2007). Statins and risk of cancer: a systematic review and metaanalysis. International journal of cancer120(4), 833-843.

 

Cauley, Jane A., et al. “Statin use and breast cancer: prospective results from the Women’s Health Initiative.” Journal of the National Cancer Institute 98.10 (2006): 700-707.

 

Goldstein, M. R., & Mascitelli, L. (2013). Do statins cause diabetes?. Current diabetes reports13(3), 381-390.

 

Kumar, Anjali S., et al. “Estrogen Receptor–Negative Breast Cancer Is Less Likely to Arise among Lipophilic Statin Users.” Cancer Epidemiology and Prevention Biomarkers 17.5 (2008): 1028-1033.

 

Manthravadi, S., Shrestha, A., & Madhusudhana, S. (2016). Impact of statin use on cancer recurrence and mortality in breast cancer: A systematic review and meta‐analysis. International journal of cancer139(6), 1281-1288.

 

McDougall, J.A., Malone, K.E., Daling, J.R., Cushing-Haugen, K.L., Porter, P.L. and Li, C.I. (2013) Long-Term Statin Use and Risk of Ductal and Lobular Breast Cancer among Women 55 to 74 Years of Age. Cancer Epidemiology, Biomarkers & Prevention, 22, 1529-1537.

 

Murtola, Teemu J., et al. “Statin use and breast cancer survival: a nationwide cohort study from Finland.” PloS one 9.10 (2014): e110231.

 

Nickels, Stefan, et al. “Mortality and recurrence risk in relation to the use of lipid-lowering drugs in a prospective breast cancer patient cohort.” PloS one 8.9 (2013): e75088.

 

Prado, Carla MM, et al. “Two faces of drug therapy in cancer: drug-related lean tissue loss and its adverse consequences to survival and toxicity.” Current Opinion in Clinical Nutrition & Metabolic Care14.3 (2011): 250-254.

 

Ravnskov, Uffe, et al. “Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review.” BMJ open 6.6 (2016): e010401.

 

Smith, Amelia, et al. “De novo post-diagnosis statin use, breast cancer-specific and overall mortality in women with stage I-III breast cancer.” (2016): 592.

 

Undela, Krishna, Vallakatla Srikanth, and Dipika Bansal. “Statin use and risk of breast cancer: a meta-analysis of observational studies.” Breast cancer research and treatment 135.1 (2012): 261-269.

 

Wilke, R.A., Lin, D.W., Roden, D.M., Watkins, P.B., Flockhart, D., Zineh, I., Giacomini, K.M. and Krauss, R.M. (2007) Identifying Genetic Risk Factors for Serious Adverse Drug Reactions: Current Progress and Challenges. Nature S. Moonindranath, H. L. Shen 29 Reviews: Drug Discovery, 6, 904-916

 

Woditschka, Stephan, et al. “Lipophilic statin use and risk of breast cancer subtypes.” Cancer Epidemiology and Prevention Biomarkers(2010): cebp-0524.

Despre Autor

Diana Artene

Sunt Nutritionist-Dietetician, Master in Nutritie si Doctor in Nutritie Oncologica, Nutritionist Sportiv acreditat de Societatea Internationala de Nutritie Sportiva si membru al American Society for Nutrition și al European Society of Medical Oncology.