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Hormon Reseptör Pozitif, İnsan Epidermal Büyüme Faktörü Reseptör2 Negatif Metastatik Meme Kanserli Hastalarda Tedavi Seçenekleri

Meme kanserleri(MK) kadınlarda en sık görülen ve ikinci sıklıkta ölüme neden olan kanserlerdir. Hastaların %3-8 metastatik evrede tanı almakta, %40’unda da takipte metastaz gelişmektedir. Bu hastaların tedavisinde visseral kriz veya endokrin tedavi direnci yoksa östrojen hormonunun reseptörlere bağlanmasını engelleyici ya da östrojen üretimini azaltıcı endokrin tedavi önerilmektedir. Çünkü metastatik MK hastalarda çok istisnai vakalar dışında kür sağlanamamaktadır. Hastalarda semptom kontrolü, hastalık progresyonunun geciktirilmesi ve hastalık progresyonuna bağlı ciddi komplikasyonlardan önlenmesi, yaşam kalitesin devam ettirebilmesi ve sonuçta sağkalım süresinin uzatılmaya çalışılmalıdır. Hastaların pre/perimenapozal veya menapozal dönemde olup olmadıkları tedavi seçiminde önemlidir. Pre/perimenapozal dönemde selektif östrojen reseptör modülatörleri (Tamoksifen), progresyon olduğunda over ablasyonu/ supresyon ile birlikte postmenapozal dönemdeki tedaviler kullanılabilir. Postmenapozal dönemde ise Tamoksifen, Aromataz inhibitörleri: nonsteroidal (Letrozol veya Anastrozol) ve steroidal (Exemestan), östrojen reseptör down regülatörü (Fulvestrant) seçenekler arasındadır. Ayrıca endokrin tedavilere direnç gelişimi durumunda etkinliğinin artırılması amacıyla siklin bağımlı kinaz 4/6 inhibitörleri (Palbociclib, Ribociclib, Abemaciclib), ve mTOR inhibitörü (Everolimus), fosfotidil inositol 3 kinaz inhibitörü (Buparlisib) gibi hedefe yönelik moleküllerle kombinasyon tedavileri uygulanabilir. Ayrıca hedefe yönelik tedavilerin endokrin tedavilerle kombinasyonları etkinliğini artırmaktadır.

Anahtar Kelimeler:

Metastatik Meme Kanseri, Endokrin Tedavi, Siklin Bağımlı Kinaz 4/6 İnhibitörleri, mTOR inhibitörü, Fosfotidil İnositol 3 Kinaz İnhibitörleri

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