HER-2 Pozitif Meme Kanserinde Neoadjuvan Tedavi
Özet
HER2 pozitif meme kanseri, agresif biyolojik özelliklerine rağmen hedefe yönelik tedavilere yüksek yanıt verme potansiyeli taşıyan bir alt tiptir. Neoadjuvan kemoterapi (NAKT), bu hasta grubunda hem cerrahi yaklaşımı kolaylaştırmak hem de sistemik hastalık kontrolünü artırmak amacıyla yaygın şekilde kullanılmaktadır. Trastuzumab, HER2 hedefli tedavinin temelidir; pertuzumabın eklenmesiyle ikili HER2 blokajı sağlanarak pCR oranları anlamlı şekilde artırılmaktadır. Geleneksel antrasiklin-taksan bazlı rejimler etkili olmakla birlikte, kardiyotoksisite gibi yan etkiler nedeniyle son yıllarda antrasiklin içermeyen taksan-karboplatin kombinasyonları daha fazla tercih edilmektedir. TRAIN-2 ve TRYPHAENA gibi çalışmalarda, bu rejimlerin benzer etkinlik sağladığı ve toksisite profilinin daha iyi olduğu gösterilmiştir. Standart tedavi seçenekleri arasında TCH(P), haftalık PCbH(P) ve AC-TH(P) rejimleri yer almakta olup rejim seçimi hastanın tümör özellikleri, komorbiditeleri ve cerrahi hedefleri göz önünde bulundurularak yapılmaktadır. Neoadjuvan tedavi sonrası elde edilen yanıt, adjuvan tedavi planlamasında yol gösterici olup, kişiselleştirilmiş, biyolojik temelli yaklaşımlar tedavi başarısını artırmaktadır.
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