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Avaliação das reações adversas em doentes com cancro da mama submetidos a terapêutica com inibidores das cinases dependentes de ciclinas (CDK) no Hospital da Senhora da Oliveira – Guimarães
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Abstract(s)
O cancro da mama é o tipo de cancro mais frequente nas mulheres em todo o mundo, principalmente em países desenvolvidos, e é também a principal causa de morte por neoplasias no sexo feminino. No entanto, a taxa de sobrevivência tem aumentado devido à deteção precoce através do reconhecimento dos primeiros sinais/sintomas, seguido de rápido diagnóstico e tratamento adequado. Associado a isto, os rastreios realizados, onde o cancro é detetado sem aparecimento de sintomas de alerta, e as novas opções terapêuticas contribuíram para aumentar as taxas de recuperação.
Tem-se assistido a uma rápida evolução no tratamento do cancro da mama, estando atualmente disponíveis várias terapêuticas como a quimioterapia por via oral ou intravenosa com recurso a agentes citotóxicos, a radioterapia, a terapêutica hormonal dirigida aos recetores de estrogénio e progesterona, os anticorpos monoclonais e as terapêuticas-alvo, que atuam por ligação a moléculas específicas.
As cinases dependentes de ciclina (CDK) representam um importante alvo terapêutico no tratamento deste cancro. Recentemente, foram aprovados os inibidores de CDK 4 e 6 palbociclib, ribociclib e abemaciclib para o tratamento do cancro da mama metastático ou localmente avançado com recetor hormonal positivo (HR+) e recetor do fator de crescimento epidérmico humano tipo 2 negativo (HER2-), em combinação com um inibidor da aromatase ou em associação com fulvestrant, em mulheres que receberam terapêutica endócrina anterior. Em mulheres pré- ou peri-menopáusicas, deve ser associado um agonista da hormona libertadora da hormona luteinizante (LHRH).
O presente estudo teve como objetivo avaliar a resposta à terapêutica de doentes com cancro da mama seguidos no Hospital da Senhora da Oliveira – Guimarães, E.P.E., comparando com os resultados apresentados nos ensaios clínicos dos 3 fármacos inibidores das CDK4/6, monitorizando os efeitos adversos e possíveis reações adversas dos medicamentos, em conjunto com a Unidade de Farmacovigilância de Guimarães.
A análise dos dados obtidos neste estudo permitiu identificar os eventos de toxicidade hematológica (principalmente neutropenia) como as reações adversas mais importantes associadas à terapêutica com inibidores das CDK4/6, verificando-se a evolução decrescente da contagem de neutrófilos após o iniciar da terapêutica e no decorrer do tratamento, principalmente entre o primeiro e o segundo ciclo.
Breast cancer is the most common type of cancer in women worldwide, mainly in developed countries, and it is also the leading cause of death from neoplasms in females. However, the survival rate has increased due to an early detection through recognition of early signs/symptoms, followed by rapid diagnosis and proper treatment. In association with the screenings performed, where cancer is detected without the appearance of warning symptoms, and new therapeutic options have contributed to increasing recovery rates. There has been a rapid evolution in the treatment of breast cancer, with various therapies currently available, such as oral or intravenous chemotherapy using cytotoxic agents, radiotherapy, hormonal therapy targeting estrogen and progesterone receptors, monoclonal antibodies, and target therapeutics, which act by binding to specific molecules. Cyclin-dependent kinases (CDK) represent an important therapeutic target in the treatment of this type of cancer. Recently, the following CDK 4 and 6 inhibitors have been approved, palbociclib, ribociclib and abemaciclib for the treatment of metastatic breast cancer or locally advanced with positive hormone receptor (HR+) and human epidermal growth factor receptor type 2 negative (HER2-), in combination with an aromatase inhibitor or in combination with fulvestrant, in women who received previous endocrine therapy. In pre- or peri-menopausal women, it should be associated with a luteinizing hormone-releasing hormone agonist (LHRH). This study aims to assess the response to therapy of patients with breast cancer followed at the Hospital da Senhora da Oliveira – Guimarães, E.P.E., comparing with the results presented in clinical trials of three CDK 4 and 6 inhibitor drugs, monitoring adverse effects and possible adverse drug reactions, together with the Guimarães Pharmacovigilance Unit. The analysis of the data obtained in this study allowed the identification of hematological toxicity events (mainly neutropenia) as the most important adverse reactions associated with therapy with CDK4/6 inhibitors, resulting in the decreasing neutrophil count after starting CDK inhibitor therapy and the course of treatment, especially between the first and second cycle.
Breast cancer is the most common type of cancer in women worldwide, mainly in developed countries, and it is also the leading cause of death from neoplasms in females. However, the survival rate has increased due to an early detection through recognition of early signs/symptoms, followed by rapid diagnosis and proper treatment. In association with the screenings performed, where cancer is detected without the appearance of warning symptoms, and new therapeutic options have contributed to increasing recovery rates. There has been a rapid evolution in the treatment of breast cancer, with various therapies currently available, such as oral or intravenous chemotherapy using cytotoxic agents, radiotherapy, hormonal therapy targeting estrogen and progesterone receptors, monoclonal antibodies, and target therapeutics, which act by binding to specific molecules. Cyclin-dependent kinases (CDK) represent an important therapeutic target in the treatment of this type of cancer. Recently, the following CDK 4 and 6 inhibitors have been approved, palbociclib, ribociclib and abemaciclib for the treatment of metastatic breast cancer or locally advanced with positive hormone receptor (HR+) and human epidermal growth factor receptor type 2 negative (HER2-), in combination with an aromatase inhibitor or in combination with fulvestrant, in women who received previous endocrine therapy. In pre- or peri-menopausal women, it should be associated with a luteinizing hormone-releasing hormone agonist (LHRH). This study aims to assess the response to therapy of patients with breast cancer followed at the Hospital da Senhora da Oliveira – Guimarães, E.P.E., comparing with the results presented in clinical trials of three CDK 4 and 6 inhibitor drugs, monitoring adverse effects and possible adverse drug reactions, together with the Guimarães Pharmacovigilance Unit. The analysis of the data obtained in this study allowed the identification of hematological toxicity events (mainly neutropenia) as the most important adverse reactions associated with therapy with CDK4/6 inhibitors, resulting in the decreasing neutrophil count after starting CDK inhibitor therapy and the course of treatment, especially between the first and second cycle.
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Keywords
Cancro da mama Inibidor CDK4/6 Abemaciclib Palbociclib Ribociclib Reações adversas Toxicidade Breast cancer CDK4/6 inhibitor Adverse drug reactions Toxicity