Tratamento sistémico do carcinoma de mama HER2 positivo com metástases cerebrais : estado atual e estudo exploratório de casos numa coorte portuguesa
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2021
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Edições Universitárias Lusófonas
Resumo
Nos últimos anos, a incidência de metástases cerebrais em doentes com cancro da mama HER2 tem aumentado. A
cirurgia e a radioterapia continuam a ser os tratamentos preferenciais. No entanto, não é claro que tratamento sistémico,
para além do tratamento local, deve ser aplicado e quando. Este trabalho visa apresentar uma revisão das atuais opções de
tratamento sistémico nos doentes com cancro da mama metastático HER2+ com metástases cerebrais e apresentar casos
clínicos ocorridos numa amostra da população portuguesa.
A metodologia deste trabalho incluiu uma pesquisa bibliográfica no PubMed sobre o impacto de agentes anti-HER2,
tais como pertuzumab, trastuzumab-emtansina (T-DM1), lapatinib, neratinib, trastuzumab-deruxtecan, e tucatinib no
tratamento de doentes com cancro da mama HER2+ com metástases cerebrais. Seguidamente, foi também analisada
uma coorte de doentes portugueses com cancro da mama HER2+ (n=44). Neste estudo exploratório, considerando um
seguimento médio de 23,9 meses, três pacientes (6,8%) desenvolveram metástases cerebrais, apesar de terem apresentado
resposta patológica completa. O papel do tratamento sistémico em doentes com cancro da mama HER2 com metástases
cerebrais evoluiu rapidamente, após os recentes sucessos em ensaios clínicos de fase II e III. O maior desafio é o de
integrar o tratamento sistémico e local na gestão destes doentes.
Over the last years, the incidence of brain metastases in HER2 breast cancer patients has increased. Surgery and radiotherapy are the current standard local therapies. Nevertheless, it is unclear which and when systemic treatment should be applied in addition to local treatment. This work aims to present an updated review of current systemic treatment options for patients with HER2+ metastatic breast cancer with brain metastases and to present a case study of clinical cases that occurred in a Portuguese population. The methodology of this work included a literature search in PubMed for the impact of HER2-targeting agents, such as pertuzumab, trastuzumab emtansine (T-DM1), lapatinib, neratinib, trastuzumab deruxtecan, and tucatinib in the treatment of patients with HER2+ breast cancer with brain metastases. Then, a cohort of Portuguese patients with HER2+ breast cancer (n=44) was analyzed. In this exploratory study, considering a follow-up of 23.9 months, three patients (6.8%) developed brain metastases despite having shown a complete pathological response. The role of systemic treatment for patients with HER2 breast cancer with brain metastases has rapidly evolved following recent successes in phase II and III clinical trials. The biggest challenge is how to integrate systemic and local treatment in the management of these patients.
Over the last years, the incidence of brain metastases in HER2 breast cancer patients has increased. Surgery and radiotherapy are the current standard local therapies. Nevertheless, it is unclear which and when systemic treatment should be applied in addition to local treatment. This work aims to present an updated review of current systemic treatment options for patients with HER2+ metastatic breast cancer with brain metastases and to present a case study of clinical cases that occurred in a Portuguese population. The methodology of this work included a literature search in PubMed for the impact of HER2-targeting agents, such as pertuzumab, trastuzumab emtansine (T-DM1), lapatinib, neratinib, trastuzumab deruxtecan, and tucatinib in the treatment of patients with HER2+ breast cancer with brain metastases. Then, a cohort of Portuguese patients with HER2+ breast cancer (n=44) was analyzed. In this exploratory study, considering a follow-up of 23.9 months, three patients (6.8%) developed brain metastases despite having shown a complete pathological response. The role of systemic treatment for patients with HER2 breast cancer with brain metastases has rapidly evolved following recent successes in phase II and III clinical trials. The biggest challenge is how to integrate systemic and local treatment in the management of these patients.
Descrição
Biomedical and biopharmaceutical research : jornal de investigação biomédica e biofarmacêutica
Palavras-chave
CIÊNCIAS FARMACÊUTICAS, BIOMEDICINA, CANCRO DA MAMA, METÁSTASES, CÉREBRO, PHARMACEUTICAL SCIENCES, BIOMEDICINE, BREAST CANCER, BRAIN