Publication: Análisis de coste-eficacia de los test genómicos en el tratamiento del cáncer de mama
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2017-09-07
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Universidad Complutense de Madrid
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Abstract
El cáncer de mama (CM) es el tumor más frecuente en mujeres con cerca de 16.000 nuevos casos por año en España. Aproximadamente la mitad de las enfermas presentan tumores con receptores hormonales positivos y sin invasión ganglionar loco-regional al diagnóstico. Este subgrupo de pacientes con CM inicial de estadio precoz ha aumentado en los últimos años gracias a la implantación de los programad de cribado y a la mayor concienciación de la población. El tratamiento adyuvante en estas pacientes se basa en la administración secuencial de quimio y hormonoterapia (QHT) o en una terapia hormonal exclusiva (HT). La recomendación final de tratamiento se basa en la valoración del riesgo individual de recaída de cada paciente unido a los beneficios y posibles efectos asociados a cada tratamiento. Tradicionalmente, la estimación del riesgo de recaída se realiza a partir de indicadores pronósticos clínico-patológicos entre los que se incluyen el tamaño del tumor, el grado, el estado de los receptores hormonales, la sobreexpresión del factor de crecimiento epidérmico humano tipo 2 (HER2) y la presencia o ausencia de afectación ganglionar locorregional. Aunque la mayor parte de las guías de práctica clínica recomiendan el tratamiento adyuvante con QHT en las pacientes con CM precoz, la realidad es que la mayoría de estas enfermas quedan libres de enfermedad tras la cirugía incluso en ausencia de quimioterapia (QT) adyuvante. Además, la QT se asocia con importante toxicidad tanto inmediata como tardía y su indicación y manejo incrementa el gasto sanitario. Por este motivo existe una clara necesidad de identificar nuevos factores pronósticos y predictivos más sensibles que seleccionen mejor a las pacientes en función de su riesgo de recaída y ayuden al clínico a afinar más en la selección del tratamiento adyuvante. En este sentido los test genómicos Oncotype Dx® y MammaPrint® se perfilan como herramientas muy prometedoras...
Breast cancer is the most frequent cancer in women with nearly 16,000 new cases per year in Spain. Nearly half of these women present with hormone-receptor positive, lymph node negative disease, a subgroup that has increased in size due largely to routine breast cancer screening and increased awareness. Adjuvant treatment for these patients may include combined chemotherapy plus hormonal therapy (CHT) or hormonal therapy alone (HT). Treatment recommendations are based on the patient’s risk of recurrence and the benefits and potential side effects of therapy. Traditionally, oncologists have used certain risk factors to help gauge the risk of recurrence of early-breast cancer including tumor size, grade, hormone receptor status, human epidermal growth factor (HER2) over-expression, and the presence or absence of lymph node involvement. Clinical practice guidelines recommend adjuvant chemotherapy in addition to hormonal therapy for most women with hormone-receptor positive, lymph node negative early breast cancer; however, the majority of these women would remain disease free even in the absence of adjuvant chemotherapy. In addition, systemic chemotherapy is associated with both immediate and delayed toxicity, as well as considerate cost. Therefore, more sensitive, objective, individualised predictive factors are needed in order to refine treatment selection. Gene expression assays of the primary tumor, such as the 21-gene recurrence score assay (Oncotype Dx®) and the 70-gene prognosis-signature (MammaPrint®), show promise in this regard...
Breast cancer is the most frequent cancer in women with nearly 16,000 new cases per year in Spain. Nearly half of these women present with hormone-receptor positive, lymph node negative disease, a subgroup that has increased in size due largely to routine breast cancer screening and increased awareness. Adjuvant treatment for these patients may include combined chemotherapy plus hormonal therapy (CHT) or hormonal therapy alone (HT). Treatment recommendations are based on the patient’s risk of recurrence and the benefits and potential side effects of therapy. Traditionally, oncologists have used certain risk factors to help gauge the risk of recurrence of early-breast cancer including tumor size, grade, hormone receptor status, human epidermal growth factor (HER2) over-expression, and the presence or absence of lymph node involvement. Clinical practice guidelines recommend adjuvant chemotherapy in addition to hormonal therapy for most women with hormone-receptor positive, lymph node negative early breast cancer; however, the majority of these women would remain disease free even in the absence of adjuvant chemotherapy. In addition, systemic chemotherapy is associated with both immediate and delayed toxicity, as well as considerate cost. Therefore, more sensitive, objective, individualised predictive factors are needed in order to refine treatment selection. Gene expression assays of the primary tumor, such as the 21-gene recurrence score assay (Oncotype Dx®) and the 70-gene prognosis-signature (MammaPrint®), show promise in this regard...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 14/11/2016