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Organo Oficial de la Asociación Mexicana de Mastología

2014, Número 3

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Rev Mex Mastol 2014; 4 (3)


Análisis de la efectividad de epirrubicina neoadyuvante de alta dosis al usar 4 vs. 6 ciclos en pacientes con cáncer de mama localmente avanzado

Ramírez-Torres N, Pérez-Puentes A, Astudillo-de la Vega H

Idioma: Español
Referencias bibliográficas: 43
Paginas: 91-99
Archivo PDF: 329.54 Kb.


RESUMEN

Propósito: Agentes citostáticos como las antraciclinas han demostrado ser eficaces en el tratamiento del cáncer de mama localmente avanzado (CMLA). La epirrubicina puede utilizarse en dosis altas sin incrementar la toxicidad severa. Nuestro objetivo fue evaluar la dosis alta de epirrubicina al usar 4 vs. 6 ciclos. Pacientes y métodos: Pacientes diagnosticadas con CMLA se incluyeron en nuestro hospital. Una cohorte (n = 48) recibió 5-fluorouracilo 500 mg/m2, epirrubicina 100 mg/m2 y ciclofosfamida 600 mg/m2 (FE100C) por cuatro ciclos (4FE100C). Otra cohorte (n = 48) recibió seis ciclos del mismo esquema (6FE100C). A todas las pacientes se les realizó cirugía, radioterapia y quimioterapia adyuvante. Resultados: Se obtuvo una tasa significativa de respuesta objetiva (RO) de 87.5% para 6FE100C frente al 62.5% para 4FE100C (p ‹ 0.004). Al aumentar el número de ciclos administrados (6FE100C) hubo una mejora no significativa en las tasas de respuesta patológica completa (RPc) (20.8%; p = 0.273) y de ganglios negativos postquimioterapia (37.5%; p = 0.960). La toxicidad predominante para 6FE100C fue vómito (52.4%; p = 0.001) y náusea (91.6%; p = .563), ambos con grado 1-2. La odds ratio indicó que el uso de 6FE100C comparado con 4FE100C incrementó 1.6 veces la posibilidad de RPc y la dosis intensiva de epirrubicina fue el factor controlable más importante para determinar la RPc sin incrementar la toxicidad severa. Conclusión: El beneficio de la respuesta clínica y patológica fue mejor para el tratamiento prolongado de seis ciclos al usar una dosis alta de epirrubicina.


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