HER2 Düşük Ekspresyonlu Meme Kanserinde Tedavi Yaklaşımları
Özet
Meme kanseri, kadınlarda en sık karşılaşılan malignite olup, biyolojik çeşitliliği nedeniyle alt gruplara ayrılarak tedavi edilmektedir. HER2 (human epidermal growth factor receptor 2) reseptörü, tedavi ve prognozda önemli bir biyobelirteçtir. Geleneksel olarak HER2 pozitif ve negatif olarak sınıflandırılan meme kanserlerinde, son yıllarda IHC +1 veya IHC +2 olup in situ hibridizasyon (ISH) negatif olan hastaları içeren "HER2 düşük ekspresyonlu" bir alt grup tanımlanmıştır. HER2 düşük tümörlerin, HER2 pozitif tümörlerden farklı biyolojik özellikler gösterdiği ve klasik kemoterapiye ek olarak anti-HER2 ajanlara sınırlı yanıt verdiği görülmüştür. Trastuzumab deruxtecan (T-DXd) gibi yeni nesil antikor-ilaç konjugatları bu alt grupta belirgin progresyonsuz sağkalım (progression free survival; PFS) ve genel sağkalım avantajı sağlamıştır. Ayrıca sacituzumab govitecan (SG) gibi diğer hedefe yönelik tedaviler de HER2 düşük ve HER2-0 hasta gruplarında umut vadetmektedir. Bununla birlikte, HER2 düşük ekspresyonun prognostik önemi, ideal tedavi sıralaması ve hasta seçim kriterleri gibi konular hâlâ araştırma alanıdır. Bu derlemede, HER2 düşük ekspresyonlu meme kanserinin tanı yöntemleri, biyolojik özellikleri ve güncel tedavi yaklaşımları detaylı şekilde ele alınmıştır.
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