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Organo Oficial de la Asociación Mexicana de Mastología

2020, Número 3

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Rev Mex Mastol 2020; 10 (3)


Actualidades en el manejo sistémico del cáncer de mama

Luna-Palencia RL, De la Cruz-Escobar EN

Idioma: Español
Referencias bibliográficas: 61
Paginas: 71-82
Archivo PDF: 223.32 Kb.


RESUMEN

El cáncer de mama representa la principal causa de muerte por cáncer en mujeres. Se distinguen cuatro fenotipos moleculares asociados a un distinto pronóstico y tratamiento. En el manejo del cáncer de mama con receptores hormonales positivos y sin sobreexpresión de HER2 el principal avance se ha visto en el contexto metastásico al agregar inhibidores de cinasas dependientes de ciclinas 4/6 al tratamiento endocrino, obteniendo medianas de supervivencia libre de progresión de 27.6 meses con palbociclib/letrozol (PALOMA-2) o de supervivencia global de 58.7 meses al agregar ribociclib al tratamiento hormonal en mujeres pre- o perimenopáusicas (MONALEESA-7). Las terapias anti-HER2 han mejorado de forma considerable el pronóstico de las pacientes con cáncer de mama con sobreexpresión del oncogén HER2, en el contexto de enfermedad temprana mediante la adyuvancia con trastuzumab o trastuzumab emtansina y en contexto metastásico agregando pertuzumab al tratamiento con trastuzumab y docetaxel (CLEOPATRA) con medianas de supervivencia global de 56.5 meses con el doble bloqueo. En el subgrupo de pacientes triple negativas, la adición de inmunoterapia con el inhibidor de PD-L1 (ligando 1 de muerte programada [en inglés: Programmed Death-Ligand 1]) atezolizumab a la quimioterapia con nab-paclitaxel (IMpassion 130) demostró una mediana de supervivencia global de 25 meses en pacientes con expresión positiva de PD-L1.


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