Hormon Pozitif Metastatik Meme Kanseri Tedavisi
Özet
Hormon reseptörü pozitif, HER2 negatif metastatik meme kanseri (HR+/HER2− MMK) genellikle endokrin temelli tedavi rejimleriyle yönetilmektedir. Viseral kriz bulunmayan hastalarda, endokrin tedavi tek başına veya hedefe yönelik ajanlarla kombinasyon halinde birinci basamak standart tedavi seçeneği olmaya devam etmektedir. Faz III klinik çalışmalarda, aromataz inhibitörleri (Aİ) ile birlikte verilen CDK4/6 inhibitörlerinin (palbosiklib, ribosiklib veya abemasiklib) progresyonsuz sağkalımı tek başına Aİ tedavisine kıyasla anlamlı şekilde uzattığı ve kabul edilebilir toksisite profiline sahip olduğu gösterilmiştir. Fulvestrant, tek başına veya CDK4/6 inhibitörleriyle kombinasyon halinde özellikle endokrin dirençli hastalarda sağkalım avantajı sağlamaktadır. MONALEESA ve MONARCH çalışmaları, gerekli durumlarda over baskılanması ile birlikte premenopozal ve postmenopozal hastalarda benzer etkinlik göstermiştir. Nötropeni ve diyare gibi yan etkiler sık görülmekle birlikte genellikle yönetilebilir niteliktedir. Birinci basamak tedavi sonrası progresyon gelişen hastalarda, ardışık endokrin tedaviler veya hedefe yönelik kombinasyonlar yararlı olmaya devam etmektedir. Güncel NCCN kılavuzları, CDK4/6 inhibitörü + Aİ veya fulvestrant kombinasyonlarını birinci kategori tedavi olarak önermektedir. Sonuç olarak, CDK4/6 inhibitörleri içeren endokrin temelli rejimler, HR+/HER2− metastatik meme kanserinde klinik sonuçları ve yaşam kalitesini iyileştiren, toksisitesi yönetilebilir tedavi yaklaşımlarıdır.
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