RESUMEN
Introduction: For decades, endocrine therapy has been the cornerstone of management for luminal breast cancer. Despite the substantial benefit derived by patients from endocrine therapy, primary and secondary resistances to endocrine therapy are serious clinical issues.Areas covered: Today, in the advanced setting, three distinct classes of targeted agents mTOR, CDK 4/6, and PI3K inhibitors, are approved for use. CDK 4/6 inhibitors have improved outcomes substantially, changing the natural history of advanced luminal breast cancer. Current studies seek to bring CDK 4/6 inhibitors to the early setting. This review will cover all available data on target therapy combinations with endocrine therapy for both the early and advanced settings, including approved drugs and agents in development.Expert opinion: Combined endocrine and target therapy has changed the landscape in advanced disease. In early disease, it is possible to have a large impact, particularly in patients with higher risk of relapse. Trials like ADAPTCYCLE seek to leverage neoadjuvant data to de-escalate treatment, substituting chemotherapy for CDK 4/6 inhibitors. In advanced diseases, studies such as PADA-1 point toward a future in which ctDNA will be used to define management before clinical progression occurs.
Asunto(s)
Neoplasias de la Mama , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/genética , Quinasa 4 Dependiente de la Ciclina , Femenino , Humanos , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Fosfatidilinositol 3-Quinasas/uso terapéutico , Inhibidores de Proteínas Quinasas/farmacología , Inhibidores de Proteínas Quinasas/uso terapéutico , Receptor ErbB-2RESUMEN
This article proposes a relational approach to the study of abortion law reform in Brazil. It focuses on the interaction of pro-choice and anti-abortion movements in different state arenas and political contexts. It details the emergence of a strategic action field on abortion during the Brazilian re-democratization process and the National Constituent Assembly. We offer analysis on pro-choice and anti-abortion mobilization in state arenas-mainly in the executive and legislative powers-during the two terms of President Fernando Henrique Cardoso (FHC), 1995-1998 and 1999-2002, and the first term of President Luís Inácio Lula da Silva (Lula), 2003-2006. We then map political resources for mobilization, such as legislative bills, public policy norms, and judicial decisions, and track legal continuities and changes. Finally, we analyze anti-abortion reaction, which was consolidated through an increased conservative presence in congress after 2006, and discuss how the abortion debate has migrated from congress to the Supreme Court and the public sphere.