Cáncer de seno y hormonoterapia. Estado actual
Palabras clave:
agentes antineoplásicos hormonales, cáncer de seno, receptores estrogénicos, quimioterapia adyuvanteResumen
El manejo del cáncer de seno es multidisciplinario e involucra la cirugía, la quimioterapia, la radioterapia y la hormonoterapia. La hormonoterapia es un tratamiento muy antiguo para el manejo efectivo del cáncer de seno hormono-sensible. Cerca de 75% de las pacientes expresan receptores hormonales en el tumor y el estándar de manejo ha sido con antiestrógenos como el tamoxifeno, que se viene usando desde hace más de 25 años en ensayos clínicos con buena respuesta, mejorando la supervivencia libre de enfermedad (SLE) y la supervivencia total (ST) de las pacientes, tanto en mujeres premenopáusicas como postmenopáusicas; por los efectos secundarios sobre endometrio y coagulación, se han venido desarrollando nuevas drogas llamadas inhibidores de aromatasa, que han sido comparados con el tamoxifeno en el estado metastásico y en adyuvancia, con mejores resultados de supervivencia libre de enfermedad con menos efectos secundarios sobre endometrio y menos eventos trombóticos, aunque aumentan el riesgo de osteoporosis y fracturas con su uso prolongado. El uso de inhibidores de aromatasa se restringe a pacientes posmenopáusicas. Las pacientes premenopáusicas requieren algún tipo de bloqueo ovárico para su uso. Se hace una revisión de la evolución del tratamiento en estos escenarios y en los nuevos terrenos de neoadyuvancia y quimioprevención.
Se considera que toda paciente con cáncer de seno que tenga alguna expresión de receptores hormonales (más de 1% por inmunohistoquímica) se beneficia de hormonoterapia; el tamoxifeno por 5 años es una excelente droga para ser utilizada en casos de muy buen pronóstico, pero cuando está contraindicado o cuando existen factores de riesgo para recaída local o sistémica, las pacientes posmenopáusicas con tumores hormonosensibles, se benefician de un inhibidor de aromatasa en adyuvancia primaria o hacer el cambio después de 2, 3 ó 5 años de tamoxifeno. La evidencia actual muestra que el tratamiento se puede prolongar más allá de los 5 a 10 años.
Este es un artículo de revisión de la hormonoterapia desde sus inicios hasta las recomendaciones actuales en los diferentes escenarios.
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Caicedo M., J. J.; Quintero, E.; Robledo, J. F.; Perry, F.; Ramírez, C.; Duarte, C.; Ángel, J.; Díaz, S.; Orozco, A.; Viaña, L. F. Cáncer De Seno Y Hormonoterapia. Estado Actual. Rev Colomb Cir 2007, 22, 47-71.
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