Efectividad de Trastuzumab en combinación con terapia sistémica en pacientes con cáncer de mama avanzados o metastásico HER2 positivos. Experiencia del Hospital México, Costa Rica
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Fecha
2017-08
Tipo
artículo original
Autores
Molina Hernández, Juan Pablo
Landaverde Recinos, Denis
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Resumen
Introducción: Este estudio reporta la efectividad y seguridad del uso de trastuzumab en combinación con terapia sistémica en el tratamiento de pacientes con cáncer de mama localmente avanzado o metastásico, HER2 positivos. Se muestra la experiencia de los primeros cinco años del uso de este fármaco en el Hospital México, San José Costa Rica.
Materiales y Métodos: Se trata de un estudio retrospectivo, observacional de pacientes con cáncer de mama HER2 positivos, con enfermedad metastásica o localmente avanzada irresecable, se analizaron los casos de enero de 2006 a diciembre 2011. El estado HER2 fue analizado mediante inmunohistoquímica, y en caso de duda con Hibridación in situ flurescente (FISH). Se reporta la efectividad del trastuzumab en combinación con quimioterapia u hormonoterapia. Así mismo se incluyó aquellos
de Costa Rica. denislandaverde@gmail.com
pacientes con metástasis cerebrales y que durante la adyuvancia recibieron trastuzumab.
Resultados: Un total de 301 expedientes fueron encontrados pero solo 39 cumplieron los criterios de inclusión. 28 pacientes (65%) recibieron trastuzumab como primera línea. 29 (67%) recibieron trastuzumab en combinación con paclitaxel (tanto en primera como líneas subsecuentes). La mediana de progresión a la primera línea con trastuzumab fue de 6.56 meses (CI95% 3.57-9.65 meses). La mediana de supervivencia reportada con quimioterapia más trastuzumab fue de 33.5 meses (CI 95% 22.1- 44.8 meses). Se reportaron 3 eventos cardiacos sintomáticos que requirieron suspensión temporal del trastuzumab. Se encontró una ten- dencia a una mejor superviviencia en pacientes con receptores de estrógeno positivos pero ésta no fue estadísticamente significativa (p=0.066). Conclusiones: En este estudio de la vida real se encuentra que trastuzumab en combinación con quimioterapia se asocia con una mediana a la progresion y superviviencia general muy similar a la reportada en los estudios de registro del tras- tuzumab. El trastuzumab tiene un perfil de car- dio-toxicidad muy favorable en esta población Latinoamericana.
Introduction: We report the effectiveness and safety profile of trastuzumab in combination with systemic treatments in an unselected group of pa- tients with unresectable locally advanced and/or metastatic HER2 positive breast cancer. This is a single center experience of the initial five years’ experience of trastuzumab in Hospital Mexico- Costa Rica. Materials and Methods: This is a retrospective and observational study of patients with HER2 positive locally advanced or metastatic breast cancer, between Jan 2006 and Dec 2011. HER2 status was confirmed by imnunohistochemistry (3+) or fluorescence in situ hybridization (FISH). We report here the data from the addition of trastuzumab to any systemic treatment used, in- cluding anti-hormonal drugs. We included pa- tients with brain metastases, as well as patients who received trastuzumab in the adjuvancy. Results: A total of 301 records were found but only 39 of them fulfill all the inclusion criteria. 28 patients (65%) received trastuzumab as first line regimen. 29 patients (67%) received trastuzumab plus paclitaxel. The median time to progression with first line chemotherapy regimen with trastuzumab was 6.56 months (CI 95% 3.57-9.65 months). The median survival re- ported with chemotherapy plus trastuzumab was 33.5 months (CI 95% 22.1- 44.8 months). Three symptomatic cardiac events were reported, and this cause a temporary withdrawal of the trastuzumab administration. There was a tendency of superior in median overall survival in patients with positive estrogen receptor status butit was not statistically significant (log rank 0.066). Conclusion: In this group of unselected patients attended in our Institution, the use chemotherapy plus trastuzumab was associated with a median time to progression and overall survival very similar to the experience reported in the pivotal trials of trastuzumab. And also de cardio-toxicity was mild in this Latin American population
Introduction: We report the effectiveness and safety profile of trastuzumab in combination with systemic treatments in an unselected group of pa- tients with unresectable locally advanced and/or metastatic HER2 positive breast cancer. This is a single center experience of the initial five years’ experience of trastuzumab in Hospital Mexico- Costa Rica. Materials and Methods: This is a retrospective and observational study of patients with HER2 positive locally advanced or metastatic breast cancer, between Jan 2006 and Dec 2011. HER2 status was confirmed by imnunohistochemistry (3+) or fluorescence in situ hybridization (FISH). We report here the data from the addition of trastuzumab to any systemic treatment used, in- cluding anti-hormonal drugs. We included pa- tients with brain metastases, as well as patients who received trastuzumab in the adjuvancy. Results: A total of 301 records were found but only 39 of them fulfill all the inclusion criteria. 28 patients (65%) received trastuzumab as first line regimen. 29 patients (67%) received trastuzumab plus paclitaxel. The median time to progression with first line chemotherapy regimen with trastuzumab was 6.56 months (CI 95% 3.57-9.65 months). The median survival re- ported with chemotherapy plus trastuzumab was 33.5 months (CI 95% 22.1- 44.8 months). Three symptomatic cardiac events were reported, and this cause a temporary withdrawal of the trastuzumab administration. There was a tendency of superior in median overall survival in patients with positive estrogen receptor status butit was not statistically significant (log rank 0.066). Conclusion: In this group of unselected patients attended in our Institution, the use chemotherapy plus trastuzumab was associated with a median time to progression and overall survival very similar to the experience reported in the pivotal trials of trastuzumab. And also de cardio-toxicity was mild in this Latin American population
Descripción
Palabras clave
Metástasis, HER2, Trastuzumab, Costa Rica, Cáncer de mama, 571.978 Tumores