Repuesta al tratamiento neoadyuvante en pacientes con cáncer de mama según subtipo molecular
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Los pacientes con cáncer de mama que reciben tratamiento sistémico buscando una reducción tumoral previo a la cirugía definitiva, no tienen la misma respuesta; esto puede estar influenciado por los subtipos intrínsecos moleculares. Objetivo. Determinar la respuesta clínica y patológica a la terapia neoadyuvante en pacientes con cáncer de mama según cada subtipo molecular, en el Hospital Teodoro Maldonado Carbo, en el período 2015 a 2017. Materiales y métodos. Diseño no experimental, transversal de tipo correlacional. Pacientes con cáncer de mama que recibieron tratamiento neoadyuvante, en su mayoría con quimioterapia basada en antraciclinas y taxanos. Se clasificó a los pacientes por sus subtipos moleculares, definidos según el consenso de expertos de cáncer de mama reunidos en San Gallen, los mismos se obtuvieron en base a las características inmunohistoquímicas de los reportes de patología que constan en el sistema AS-400. Se comprobó la respuesta clínica al tratamiento usando los criterios RECIST 1.1. Resultados. 171 pacientes fueron analizados. La edad promedio fue 55+13 años; el 25% fueron luminal B (HER2+), 24% luminal B (HER2-), 22% triple negativo, 18% HER2+ y 12% luminal A; el 52% de los pacientes tuvieron estadio III de la enfermedad; el 75% (129) de los pacientes se realizó una mastectomía radical modificada. Conclusiones. La respuesta patológica completa se relaciona con los subtipos moleculares y esto es estadísticamente significativo. Además, se evidenció las mayores tasas de respuesta patológica completa en los grupos moleculares de HER2+ y triple negativo.
Palabras clave: Cáncer; mama; subtipo molecular; terapia neoadyuvante; receptores; estrógeno; progesterona; HER-2.
ABSTRACT
Patients with breast cancer who receive systemic treatment seeking a tumor reduction prior to definitive surgery, do not have the same response; this may be influenced by the intrinsic molecular subtypes. Objective. To determine the clinical and pathological response to neoadjuvant therapy in patients with breast cancer according to each molecular subtype, at Teodoro Maldonado Carbo Hospital, in the period 2015 to 2017. Materials and methods. Non-experimental, cross-correlated type design. Patients with breast cancer who received neoadjuvant chemotherapy, mostly anthracyclines and taxanes-based chemotherapy. The patients were classified by their molecular subtypes, defined according to the consensus of breast cancer experts gathered in St. Gallen. They were obtained based on the immunohistochemical characteristics of the pathology reports included in the AS-400 system. The clinical response to treatment was checked using the RECIST 1.1 criteria. Results. 171 patients were analyzed. The average age was 55 + 13 years old; 25% were luminal B (HER2+), 24% luminal B (HER2-), 22% triple negative, 18% HER2 + and 12% luminal A; 52% of patients had stage III disease; 75% (129) of patients underwent a modified radical mastectomy. Conclusions. The complete pathological response is related to the molecular subtypes and this is statistically significant. In addition, the highest rates of complete pathological response were evidenced in the molecular groups of HER2 + and triple negative.
Patients with breast cancer who receive systemic treatment seeking a tumor reduction prior to definitive surgery, do not have the same response; this may be influenced by the intrinsic molecular subtypes. Objective. To determine the clinical and pathological response to neoadjuvant therapy in patients with breast cancer according to each molecular subtype, at Teodoro Maldonado Carbo Hospital, in the period 2015 to 2017. Materials and methods. Non-experimental, cross-correlated type design. Patients with breast cancer who received neoadjuvant chemotherapy, mostly anthracyclines and taxanes-based chemotherapy. The patients were classified by their molecular subtypes, defined according to the consensus of breast cancer experts gathered in St. Gallen. They were obtained based on the immunohistochemical characteristics of the pathology reports included in the AS-400 system. The clinical response to treatment was checked using the RECIST 1.1 criteria. Results. 171 patients were analyzed. The average age was 55 + 13 years old; 25% were luminal B (HER2+), 24% luminal B (HER2-), 22% triple negative, 18% HER2 + and 12% luminal A; 52% of patients had stage III disease; 75% (129) of patients underwent a modified radical mastectomy. Conclusions. The complete pathological response is related to the molecular subtypes and this is statistically significant. In addition, the highest rates of complete pathological response were evidenced in the molecular groups of HER2 + and triple negative.
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Neoplasias de la mama, Subtipos moleculares, Terapia neoadyuvante, Estrógenos, Progesterona, Receptor ErbB-2, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador