RESUMO
The management of breast cancer has changed at both surgery levels, with the development of sentinel node, and at the medical level with the use of new therapies. Breast cancer is a heterogeneous disease and each patient should be offered an adapted treatment in an effort to reduce the risk of relapse and death, with the minimal toxicities. The micrometastatic disease appears early in the history of the tumor and chemotherapy aims to eradicate it. In this review, we describe the state of practice regarding adjuvant and neoadjuvant chemotherapy for early breast cancer.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Antraciclinas/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Antineoplásicos/uso terapêutico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante/tendências , Ciclofosfamida/uso terapêutico , Feminino , Fluoruracila/uso terapêutico , Humanos , Terapia Neoadjuvante/tendências , Taxoides/uso terapêutico , TrastuzumabRESUMO
The standard treatment for advanced ovarian cancer consist in complete surgical debulking and intravenous platin and taxane based chemotherapy. Despite research efforts, a lot of patients still die from peritoneal carcinomatosis. The aim of our work was to present the state of art about intraperitoneal chemotherapy. Intraperitoneal chemotherapy (IPC): three multi-institutional randomised trials showed that platin based IPC gave better results in term of overall and disease free survival when compared to standard intravenous treatment. Even so, IPC is not yet becoming a new international standard of treatment because a high rate of morbidity. Hyperthermic Intraperitoneal chemotherapy (HIPEC) represents an innovative alternative to IPC. HIPEC is based on a complete surgical debulking without any visible mass and an intraperitoneal chemotherapy with synergy of hyperthermia. Phase II trails have shown its feasibility. Randomised trials are needed to assess its efficiency in improving survival.
Assuntos
Antineoplásicos/administração & dosagem , Neoplasias Ovarianas/tratamento farmacológico , Peritônio/efeitos dos fármacos , Antineoplásicos/efeitos adversos , Ensaios Clínicos Fase II como Assunto , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Hipertermia Induzida , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Compostos de Platina/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Taxoides/administração & dosagemRESUMO
Lapatinib is an oral, small-molecule, dual kinase inhibitor that targets both HER2 and the EGF receptor. Lapatinib was approved in June 2008 in Europe for the treatment of advanced HER2-positive breast cancer. Promising results in trastuzumab-refractory metastatic breast cancer were obtained from Phase I, II and III studies in combination with chemotherapy. Diarrhea and rash are the most common side-effects and are mostly moderate and treatable. Cardiac toxicity occurs rarely and mostly as an asymptomatic and reversible decrease of left ventricular ejection fraction. Unlike trastuzumab, some data show that lapatinib could cross the blood-brain barrier, with some evidence of activity in treating or preventing brain metastases. Its evaluation is actively ongoing, in combination with trastuzumab and in the adjuvant setting.