ON O T ER A PI A A D JU V A N TA

HORM E
IN CANCER E LE M A M A R
HORMON O S EN S IB I LE
DR. BARBU SORELA

GIE MEDICALA AN IV
MEDIC REZIDENT ONCOLO
ONCOHELP, TIMISOARA
CE SUNT CANCERELE MAMARE HORMONO-SENSIBILE?
(1)
• CE SUNT HORMONII?
• CARE SUNT PRINCIPALII HORMONI IMPLICATI IN NEOPLAZIILE
MAMARE?
• UNDE SUNT PRODUSI ACESTI HORMONI?
• CARE E ROLUL LOR?
CE SUNT CANCERELE MAMARE HORMONOSENSIBILE? (2)

• CE INSEAMNA CANCER MAMAR

HORMONOSENSIBIL?
• CARE SUNT PRINCIPALELE
SUBTIPURI?
CARE ESTE ROLUL HORMONOTERAPIEI ADJUVANTE?

• SCADEREA RISCULUI DE RECURENTA IPSI SI CONTRALATERAL

• SCADEREA RISCULUI DE METASTAZARE AL EVENTUALELOR DEPOZITE MICROMETASTATICE RAMASE
• FACTORII DE RISC PENTRU RECURENTA?
• RELATIE DIRECT PROPORTIONALA INTRE NIVELUL ER SI RISCUL DE RECURENTA
• MOMENTUL IDEAL ?
ALEGEREA HORMONOTERAPIEI

• DE CE ANUME TINEM CONT?

• PRE- SAU POSTMENOPAUZALA
• IA VS SERM
• DURATA?
TAMOXIFEN
• RECEPTOR MODULATOR SELECTIV AL ESTROGENULUI (SERM)
• INHIBA RECEPTORII SEMNALIZATORI AI ESTROGENULUI
• EFICENT PRE- SI POSTMENOPAUZA
• STIMULEAZA RECEPTORII DE ESTROGEN DIN ALTE TESUTURI
• PREZERVA DENSITATEA OSOASA, CRESTE RISCUL DE NEOPLASM ENDOMETRIAL
• AMPLIFICAREA ESR1
• CYP2D6
• SCADE RISCUL CU APROXIMATIV 50%
INHIBITORII DE AROMATAZA
• PRINCIPALA SURSA DE ESTROGEN POSTMENOPAUZA- AROMATAZA
• INHIBA ENZIMA AROMATAZA -> DEPLETIE DE ESTROGEN
• SCADE PRODUCTI DE ESTROGEN POSTMENOPAUZAL PANA LA 90%
• PREMENOPAUZA – ATENTIE LA FUNCTIA OVARIANA RESTANTA
• STEROIDIENI SI NESTEROIDIENI
• OSTEOPOROZA
ABLATIA OVARIANA
• CASTRARE CHIMICA
• CRESTE SUPRAVIETUIREA FARA PROGRESIE IN COMBINATIE
HT

• SCADE RISCUL DE RECURENTA

• POATE SA SCADA CALITATEA VIETII
• STUDIILE SOFT SI TEXT
CE, CUM, CAT?
HOW MUCH IS TOO MUCH?

• TENDINTA DE EXAGERARE?
• EMPATIE?
• ESCALADARE SAU DEESCALADARE?
THE FUTURE IS NEAR, THE FUTURE IS HERE
VA MULTUMESC!
 BIBLIOGRAFIE
• EARLY BREAST CANCER: ESMO CLINICAL PRACTICE GUIDELINES FOR DIAGNOSIS, TREATMENT AND FOLLOW-UP, F. CARDOSO , S. KYRIAKIDES , S. OHNO , ET AL. 04.06.2019
• NCCN BREAST CANCER GUIDELINE, VER 1.2021
• ESO ESMO 4TH INTERNATIONAL CONSENSUS GUIDELINES FOR BREAST CANCER IN YOUNG WOMEN (BCY4) S. PALUCH-SHIMON, F. CARDOSO , A. H. PARTRIDGE , ET AL.
• WHAT IS THE ROLE OF HORMONE THERAPY IN THE ADJUVANT TREATMENT OF BREAST CANCER? (MEDSCAPE.COM) ACC 02.03.21 13:20
• ADJUVANT ENDOCRINE THERAPY FOR WOMEN WITH HORMONE RECEPTOR–POSITIVE BREAST CANCER: ASCO CLINICAL PRACTICE GUIDELINE FOCUSED UPDATE HAROLD J.
BURSTEIN, CHRISTINA LACCHETTI, HOLLY ANDERSON, THOMAS A. BUCHHOLZ, NANCY E. DAVIDSON, KAREN A. GELMON, SHARON H. GIORDANO, CLIFFORD A.
HUDIS, ALEXANDER J. SOLKY, VERED STEARNS, ERIC P. WINER, AND JENNIFER J. GRIGGS, JOURNAL OF CLINICAL ONCOLOGY 2019 37:5, 423-438.

• WWW.CANCER.ORG/CANCER/BREAST-CANCER/TREATMENT/HORMONE-THERAPY-FOR-BREAST-CANCER.HTML ACC 1:24 02.03.2021

• CANCER PRINCIPLES AND PRACTICE OF ONCOLOGY, 11 EDITION, VICENT T. DEVITA JR, THEODORE S. LAWRANCE, STEVEN A. ROSENBERG 12.2019
TH

• MONARCHE COMMITTEE MEMBERS AND INVESTIGATORS. ABEMACICLIB COMBINED WITH ENDOCRINE THERAPY FOR THE ADJUVANT TREATMENT OF HR+, HER2-, NODE-
POSITIVE, HIGH-RISK, EARLY BREAST CANCER (MONARCHE). J CLIN ONCOL. OHNSTON SRD, HARBECK N, HEGG R, TOI M, MARTIN M, ET AL; 2020 DEC 1;38(34):3987-3998. DOI:
10.1200/JCO.20.02514. EPUB 2020 SEP 20.

• 8-YEAR UPDATE OF SOFT AND TEXT TRIALS - THE ASCO POST STEVEN E. VOGL, MD 25 JUL 2018
• ATTOM: LONG-TERM EFFECTS OF CONTINUING ADJUVANT TAMOXIFEN TO 10 YEARS VERSUS STOPPING AT 5 YEARS IN 6,953 WOMEN WITH EARLY BREAST CANCER. RICHARD
G. GRAY , DANIEL REA , KELLY HANDLEY ET AL

• BENEFIT FROM EXEMESTANE AS EXTENDED ADJUVANT THERAPY AFTER 5 YEARS OF ADJUVANT TAMOXIFEN: INTENTION-TO-TREAT ANALYSIS OF THE NATIONAL SURGICAL
ADJUVANT BREAST AND BOWEL PROJECT B-33 TRIAL, ELEFTHERIOS P MAMOUNAS 1, JONG-HYEON JEONG, D LAWRENCE WICKERHAM, ET AL

• OPTIMAL DURATION OF EXTENDED ADJUVANT ENDOCRINE THERAPY FOR EARLY BREAST CANCER; RESULTS OF THE IDEAL TRIAL (BOOG 2006-05)
• OPTIMAL DURATION OF EXTENDED ADJUVANT ENDOCRINE THERAPY FOR EARLY BREAST CANCER; RESULTS OF THE IDEAL TRIAL (BOOG 2006-05), ERIK J BLOK , JUDITH R
 1

KROEP 1, ELMA MEERSHOEK-KLEIN KRANENBARG 1, ET AL