Title ANALIZA PRVE LINIJE LIJEČENJA METASTATSKOG HER-2 POZITIVNOG RAKA DOJKE
Title (english) ANALYSIS OF THE FIRST LINE TREATMENT OF METASTATIC HER-2 POSITIVE BREAST CANCER
Author Vlasta Predovan
Mentor Ingrid Belac-Lovasić (mentor)
Committee member Duška Petranović (predsjednik povjerenstva)
Committee member Toni Valković (član povjerenstva)
Committee member Ingrid Belac-Lovasić (član povjerenstva)
Granter University of Rijeka Faculty of Health Studies (Department of Midwifery) Rijeka
Defense date and country 2018-09-28, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Radiotherapy and Oncology
Abstract Rak dojke je najučestaliji rak u žena i ujedno vodeći uzrok smrti žena oboljelih od malignih oboljenja. Prema podatcima Globocan-a iz 2012.godine 1,7 milijuna žena oboljelo je od raka dojke, a 522 000 ih je umrlo. Procjenjuje se da je od 2008. godine incidencija raka dojke porasla za više od 20%, a smrtnost za 14%.
Prema podatcima Registra za rak Hrvatskog zavoda za javno zdravstvo za 2015. godinu, s udjelom od 26% među sijelima karcinoma, karcinom dojke je najučestaliji karcinom u žena u Republici Hrvatskoj. Od karcinoma dojke u Republici Hrvatskoj je 2015. godine oboljelo 2748 žena.
Incidencija raka dojke je u porastu diljem svijeta, kao i mortalitet, osim u visoko razvijenim zemljama gdje stopa smrtnosti pada.
Rak dojke je među vodećim javnozdravstvenim problemima razvijenih zapadnih zemalja jer svaka osma žena oboljeva od raka dojke. Unatoč napretku dijagnostike i terapije još uvijek značajan broj žena umire od te bolesti. Različiti klinički ishodi i odgovor na terapiju uvjetovani su biološkim različitostima tumora. Personalizirana terapija u liječenju karcinoma dojke poboljšava ishode liječenja.
Unatoč poboljšanju dijagnostike i liječenja bolesnica s rakom dojke, pojava udaljenih metastaza i dalje je učestala. Kod 20 - 30% pacijentica s ranim stadijem karcinoma dojke doći će do pojave udaljenih metastaza. Rizik povrata bolesti ovisi o biološkim karakteristikama tumora te o stadiju bolesti. Veličina tumora, zahvaćenost limfnih čvorova, stanje hormonskih receptora i ekspresija receptora za humani epidermalni čimbenik rasta 2 neovisni su čimbenici rizika povrata bolesti.
Među etiološkim čimbenicima je i aktivacija protoonkogena HER-2/neu. Nalaz HER-2 ima prognostičku i prediktivnu važnost, javlja se u 15 - 20% karcinoma dojke u ranom stadiju bolesti te je u koleraciji s agresivnijim ponašanjem tumora. Takav nalaz korelira s lošijim odgovorom na antihormonalno liječenje. Prekomjernom ekspresijom proteina HER-2 smatra se samo nalaz 3+ što odgovara difuznom, jako pozitivnom membranskom bojanju i predstavlja indikaciju za liječenje anti HER-2 terapijom.
Metastaze udaljenih organa uglavnom se smatraju neizlječivima i uzrok su većine smrti od karcinoma. HER-2 pozitivni karcinomi dojke skloni su metastaziranju u visceralne organe, predominantno u jetru, pluća, te mozak i kosti.
U prvoj liniji liječenja metastatskog HER-2 pozitivnog karcinoma dojke koristi se kombinacija anti HER-2 i citostatske terapije ili anti HER-2 i hormonske terapije.
U radu je analiziran broj i način liječenih bolesnica u prvoj liniji metastatskog HER-2 pozitivnog raka dojke tijekom 2015. i 2016. godine u KBC Rijeka. Od prosinca 2015. godine HZZO je odobrio dvojnu anti HER-2 terapiju (trastuzumab i pertuzumab) uz taksane, a do kraja 2015. godine u rutinskoj kliničkoj praksi prema preporukama HZZO bilo je indicirano liječenje samo taksanima i trastuzumabom. U radu je analiziran broj primjenjenih ciklusa do progresije bolesti, odnosno završetka praćenja. Učinjena je i analiza i usporedba financijskih troškova liječenja. tijekom dvije godine anti HER-2 terapije naših bolesnica u Klinici za radioterapiju i onkologiju.
Abstract (english) Breast cancer is the most common type of cancer in women and is also the leading cause of death in women suffering from malignant illnesses. According to Globocan data from 2012, 1.7 million women have developed breast cancer and 522,000 died from it. It is estimated that the incidence of breast cancer has increased by more than 20% and mortality by 14% since 2008.
According to the Croatian National Cancer Registry of Croatian Institute of Public Health (Registar za rak Hrvatskog zavoda za javno zdravstvo) for 2015, with a rate of 26% among all cancer sites, breast cancer is the most common type of cancer in women in the Republic of Croatia. In 2015, 2748 women developed breast cancer in the Republic of Croatia.
The incidence of breast cancer as well as mortality are increasing worldwide, except in highly developed countries where the mortality rate has been declining.
Breast cancer is one of the leading public health problems of developed Western countries because one in eight women develops breast cancer. Despite the progress of diagnostics and therapy, a significant number of women sill die from this disease. Various clinical outcomes and response to therapy depend on biological diversity in tumors. Personalized therapy in treating breast cancer improves the outcome of the treatment.
Despite the progress in diagnostics and treatment of breast cancer patients, the occurrence of distant metastases is still frequent. In 20 to 30% of patients with early stages of breast cancer, incidence of distant metastases is observed. The risk of recurrence depends on the biological characteristics of the tumor and the stage of the disease. Tumor size, lymph node involvement, hormone receptor status and receptor expression of the human epidermal growth factor receptor 2 are various independent prognostic factors of recurrence.
One of the etiological factors is the activation of the HER-2/neu proto-oncogene. The finding of HER-2 has a prognostic and predictive value, occurs in 15 to 20% of early stage breast cancers and correlates with more aggressive tumor behavior. Such a finding correlates with a poorer response to antihormonal treatment. Excessive expression of HER-2 protein is considered only as a 3+ finding, which results in a diffuse, highly positive membrane coloration and is an indication for treatment with anti HER-2 therapy.
Metastases at distant organ sites are generally considered incurable and are the cause of most cancer-related deaths. HER-2 positive breast cancers are more likely to metastasize to visceral organs, predominantly liver, lungs, brain and bone.
In the first-line treatment of the metastatic HER-2 positive breast cancer, a combination of anti HER-2 and cytostatic therapy or anti HER-2 and hormone therapy is administered.
The paper analyzes the number and type of first-line treatment in patients with metastatic HER-2 positive breast cancer during 2015 and 2016 in Clinical Hospital Center Rijeka (KBC Rijeka). Since December 2015, in addition to taxanes, the Croatian Health Insurance Fund (HZZO) approved the dual anti-HER2 therapy (trastuzumab and pertuzumab). According to recommendations of the Fund (HZZO), up to 2015, the routine clinical practice included treatment with taxanes and trastuzumab only. The paper analyzes the number of cycles applied until the progression of the disease, ie the completion of the monitoring. An analysis and comparison of the financial cost of treatment for the period of two years of anti-HER2 therapy administered to the patients at the Clinic for Radiotherapy and Oncology was made.
Keywords
metastatski rak dojke
trastuzumab
pertuzumab
cleopatra studija
liječenje
Keywords (english)
metastatic breast cancer
trastuzumab
pertuzumab
cleopatra study
treatment
Language croatian
URN:NBN urn:nbn:hr:184:884763
Study programme Title: Graduate university study of Nursing: Healthcare Management (Biomedicine and Healthcare; clinical medical sciences) Study programme type: university Study level: graduate Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
Type of resource Text
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Created on 2019-04-10 11:45:50