Tom 8, Nr 5 (2022)
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Opublikowany online: 2021-10-25
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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Praktyczne zasady stosowania hormonoterapii uzupełniającej u chorych na raka piersi na podstawie danych z badań klinicznych

Anna Zadrożna-Nowak1, Sylwia Dębska-Szmich1, Piotr Potemski1
Onkol Prakt Klin Edu 2022;8(5):354-373.

Streszczenie

Hormonoterapię uzupełniającą stosuje się w leczeniu radykalnym chorych na raka piersi, jeżeli w tkance nowotworu potwierdzono ekspresję receptorów steroidowych, co dotyczy ponad 60% chorych. Lekami, które mają zastosowanie w tym wskazaniu, są tamoksyfen i inhibitory aromatazy, przy czym te ostatnie wskazane są u chorych po menopauzie. Do końca ubiegłego wieku standardowa hormonoterapia uzupełniająca polegała na 5-letnim leczeniu tamoksyfenem, co w porównaniu z brakiem hormonoterapii zmniejszało względne ryzyko nawrotu o 40% i zgonu o 32%. Po opublikowaniu wyników badań ATAC oraz BIG1-98, w których wykazano większą korzyść ze stosowania inhibitorów aromatazy niż tamoksyfenu u kobiet po menopauzie, w tej grupie chorych w pierwszej kolejności zaleca się obecnie stosowanie inhibitorów aromatazy. U chorych z większym ryzykiem nawrotu po leczeniu miejscowym należy rozważyć eskalację 5-letniej hormonoterapii, polegającą na jej wydłużeniu lub skojarzeniu z supresją jajników. W badaniach ATLAS i aTTom wykazano korzyść z wydłużenia leczenia tamoksyfenem do 10 lat. Ponadto wydłużenie czasu trwania hormonoterapii ponad 5 lat z zastosowaniem inhibitora aromatazy przez przynajmniej część tego okresu umożliwia wydłużenie czasu przeżycia wolnego od choroby, czasu przeżycia zależnego od raka piersi i zmniejszenie ryzyka zachorowania na raka drugiej piersi. Wyniki badań SOFT i TEXT wskazują, że skojarzenie tamoksyfenu lub inhibitorów aromatazy z supresją jajników u chorych w wieku przedmenopauzalnym zwiększa odsetek chorych przeżywających co najmniej 8 lat bez choroby w porównaniu z 5-letnim stosowaniem tamoksyfenu. W artykule omówiono mechanizmy działania leków hormonalnych, zasady ustalania wskazań do hormonoterapii, wybór momentu jej rozpoczęcia i czasu trwania, monitorowanie i leczenie działań niepożądanych oraz leczenie wspomagające i poprawiające jakość życia chorych. 

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