İleri Evre Meme Kanserinde Visseral Kriz: Tanı ve Tedavi Yaklaşımı
Özet
Meme kanseri, kadınlarda en sık görülen ve en fazla ölüme yol açan kanser türüdür. İleri evre meme kanseri hastalarının bir kısmında visseral kriz (VK) tablosu görülebilmektedir. VK, hızlı organ disfonksiyonu ile karakterize yaşamı tehdit eden bir durumdur ve acil tedavi gerektirir. Mevcut kılavuzlar VK yönetiminde kombinasyon kemoterapisini önerse de, tedavi seçiminde net bir protokol bulunmamaktadır. Retrospektif çalışmalar VK tablosu bulunan hastalarda prognozun kötü olduğunu göstermektedir. VK tedavisinde kombinasyon kemoterapileri standart tedavi olmasına rağmen, hastalarda tolerasyon sorunları ve toksisitelere yol açmaktadır. Son dönemde, CDK4/6 inhibitörlerinin etkinliğini araştıran RIGHT Choice çalışması, Ribosiklib+Endokrin tedavinin kemoterapiye kıyasla daha uzun progresyonsuz sağkalım ve daha iyi tolerabilite sağladığını göstermiştir. Ayrıca, retrospektif veriler, VK tablosunda endokrin tedavi veya anti-HER2 ajan kullanımının kemoterapiye göre daha iyi sonuçlar verebileceğini düşündürmektedir. VK’de tedavi stratejilerini iyileştirmek için antikor-ilaç konjugatları gibi yeni ilaç sınıflarının etkinliğini değerlendiren prospektif çalışmalara ihtiyaç vardır. Ayrıca, güvenilir prognostik faktörlerin eksikliği, aktif tedavi ile palyatif bakım arasında doğru seçim yapmayı güçleştirmektedir.
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