Premenopozal Kadınlarda Adjuvan Endokrin Tedavi
Özet
Premenopozal kadınlarda hormon reseptör pozitif erken evre meme kanserinde adjuvan endokrin tedavi, hastalık nüks riskini azaltmada ve sağkalımı artırmada temel yaklaşımdır. Menopozal durumun doğru belirlenmesi tedavi planlamasında kritik öneme sahiptir. Premenopozal hastalarda tamoksifen tek başına düşük ve orta riskli olgularda etkili iken, yüksek riskli hastalarda over fonksiyon baskılaması (OFB) ile birlikte aromataz inhibitörleri (AI) önerilmektedir. SOFT ve TEXT çalışmalarının 12 yıllık sonuçları, AI+OFB kombinasyonunun tamoksifen+OFB’ye kıyasla rekürrens riskini anlamlı şekilde azalttığını göstermiştir. Endokrin tedavinin standart süresi 5 yıl olup, ATLAS ve aTTom çalışmalarına göre 10 yıla uzatıldığında nüks ve mortalitede belirgin azalma sağlanmaktadır. Ayrıca yüksek riskli, HR pozitif ve HER2 negatif hastalarda CDK4/6 inhibitörleri (abemasiclib, ribociclib) eklenmesi invaziv hastalıksız sağ kalım oranlarını artırmaktadır. Güncel NCCN ve ESMO kılavuzları, yüksek riskli premenopozal hastalarda AI+OFB kombinasyonunu birinci basamak tedavi olarak önermektedir. Premenopozal hastalarda tek başına AI kullanımı önerilmemektedir.
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