| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 961.17 KB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
O cancro da mama representa a neoplasia com maior incidência no sexo feminino a nível mundial. Apresenta características heterogéneas, constituindo vários subtipos: receptores de estrogénio positivos/luminal-like A e B, basal-like, HER-2 positivo e o normal breast-like. As características dos marcadores moleculares do cancro da mama são o auxílio fundamental para a diferenciação entre os vários subtipos moleculares. Esses marcadores são os receptores de estrogénio e progesterona, o receptor HER-2, o antigénio Ki67, o gene TP53 e os genes de susceptibilidade do cancro da mama (BRCA1 e BRCA2). O cancro da mama metastizado (estadio IV) define-se pela invasão do tumor para territórios para além da mama, parede torácica e gânglios linfáticos regionais. A terapêutica desta entidade é sempre controversa. A Direcção Geral da Saúde publicou a norma 028/2012 com o intuito de fornecer normas de orientação para os profissionais de saúde nos melhores esquemas terapêuticos. Com receptores hormonais positivos e HER-2 positivo, a terapêutica endócrina, a quimioterapia e a terapêutica biológica são os esquemas a preferir. Com o intuito da melhor compreensão da norma portuguesa, foram avaliadas várias recomendações internacionais para comparação. A análise detalhada dessas recomendações revelou que as melhores combinações de terapêuticas são a terapêutica endócrina, consoante o status hormonal, com tamoxifeno e inibidores da aromatase, em combinação com a terapêutica biológica, com trastuzumab ou lapatinib, nos casos em que a quimioterapia não se encontra indicada. Aquando da indicação para a quimioterapia, esta deve ser combinada com a terapêutica biológica. Os melhores esquemas de quimioterapia contêm taxanos após a progressão com antraciclinas, e a monoterapia em sequência é preferencial. A combinação de agentes citotóxicos fica indicada nos casos de progressão em monoterapia e doença rapidamente progressiva e ameaçadora à vida, combinando-se taxanos e antraciclinas com agentes como a ciclofosfamida, fluoracilo, capecitabina, gemcitabina, vinorelbina, entre outros. Os bifosfonatos e a radioterapia encontram-se reservados para as metástases ósseas e a radioterapia holocraneana e a rádiocirurgia esterotáxica para as metástases cerebrais. Encontram-se similaridades entre a norma portuguesa e as recomendações internacionais. No entanto, existem discrepâncias principalmente nas recomendações sobre quimioterapia e terapêutica biológica. Vários agentes são sugeridos pela norma portuguesa, mas esta não apresenta esquemas definidos que poderiam ser os mais apropriados para este subtipo, revelando a insuficiência desta norma. Sugere-se a readaptação dos algoritmos adequados a cada subtipo molecular de cancro da mama metastático.
Breast cancer is the highest incidence cancer in females worldwide. It presents with heterogeneous characteristics, constituting several subtypes: positive estrogen receptors/luminal-like A and B, basal-like, HER2-positive and normal breast-like. The features of molecular markers of breast cancer are fundamental for the aid on distinction between the various molecular subtypes. These markers are estrogen and progesterone receptors, HER- 2 receptor, the Ki-67 antigen, TP53 gene and the susceptibility genes in breast cancer (BRCA1 and BRCA2). Metastatic breast cancer (stage IV) is defined by invasion of the tumor to areas other than the breast, chest wall and regional lymph nodes. The treatment of this entity is always controversial. The Direcção Geral da Saúde published the guideline 028/2012 in order to provide appropriate guidance to health professionals on the best regimens. In the cases of hormone receptor-positive and HER2-positive, endocrine therapy, chemotherapy and biological therapy are the schemes to prefer. With the aim of better understanding the Portuguese guideline, several international recommendations have been evaluated for comparison. Detailed analysis of these recommendations showed that the best combination therapies are endocrine therapy, depending on the hormonal status, with tamoxifen and aromatase inhibitors, in combination with biological therapy, such as trastuzumab or lapatinib, when chemotherapy is not indicated. When there is indication for chemotherapy, it should be combined with biological therapy. The best chemotherapy regimens are the ones containing taxanes, after progression with anthracyclines, and sequential monotherapy is preferred. The combination of cytotoxic agents is indicated in cases of progression on monotherapy and rapidly progressive, life-threatening disease by combining taxanes and anthracyclines with agents such as cyclophosphamide, fluorouracil, capecitabine, gemcitabine, vinorelbine, among others. Bisphosphonates and radiotherapy are reserved for bone metastases and whole brain radiotherapy and stereotactic radiosurgery for brain metastases. There are similarities between the Portuguese guideline and the international recommendations. However, discrepancies exist mainly in the recommendations on chemotherapy and biological therapy. Several agents are suggested by the Portuguese guideline, but there are no defined schemes that might be most appropriate for this subtype, revealing the insufficiency of this guideline. Appropriate adjustment of the algorithms for each molecular subtype of metastatic breast cancer is suggested.
Breast cancer is the highest incidence cancer in females worldwide. It presents with heterogeneous characteristics, constituting several subtypes: positive estrogen receptors/luminal-like A and B, basal-like, HER2-positive and normal breast-like. The features of molecular markers of breast cancer are fundamental for the aid on distinction between the various molecular subtypes. These markers are estrogen and progesterone receptors, HER- 2 receptor, the Ki-67 antigen, TP53 gene and the susceptibility genes in breast cancer (BRCA1 and BRCA2). Metastatic breast cancer (stage IV) is defined by invasion of the tumor to areas other than the breast, chest wall and regional lymph nodes. The treatment of this entity is always controversial. The Direcção Geral da Saúde published the guideline 028/2012 in order to provide appropriate guidance to health professionals on the best regimens. In the cases of hormone receptor-positive and HER2-positive, endocrine therapy, chemotherapy and biological therapy are the schemes to prefer. With the aim of better understanding the Portuguese guideline, several international recommendations have been evaluated for comparison. Detailed analysis of these recommendations showed that the best combination therapies are endocrine therapy, depending on the hormonal status, with tamoxifen and aromatase inhibitors, in combination with biological therapy, such as trastuzumab or lapatinib, when chemotherapy is not indicated. When there is indication for chemotherapy, it should be combined with biological therapy. The best chemotherapy regimens are the ones containing taxanes, after progression with anthracyclines, and sequential monotherapy is preferred. The combination of cytotoxic agents is indicated in cases of progression on monotherapy and rapidly progressive, life-threatening disease by combining taxanes and anthracyclines with agents such as cyclophosphamide, fluorouracil, capecitabine, gemcitabine, vinorelbine, among others. Bisphosphonates and radiotherapy are reserved for bone metastases and whole brain radiotherapy and stereotactic radiosurgery for brain metastases. There are similarities between the Portuguese guideline and the international recommendations. However, discrepancies exist mainly in the recommendations on chemotherapy and biological therapy. Several agents are suggested by the Portuguese guideline, but there are no defined schemes that might be most appropriate for this subtype, revealing the insufficiency of this guideline. Appropriate adjustment of the algorithms for each molecular subtype of metastatic breast cancer is suggested.
Description
Keywords
Cancro da Mama Metastático Her-2 Re Rp Tratamento