RESUMEN
HER2-positive breast cancer accounts for 15-20% of all breast cancer cases. This subtype is characterized by an aggressive behavior and poor prognosis. Anti-HER2 therapies have considerably improved the natural course of the disease. Despite this, relapse still occurs in around 20% of patients due to primary or acquired treatment resistance, and metastasis remains an incurable disease. This article reviews the main mechanisms underlying resistance to anti-HER2 treatments, focusing on newer HER2-targeted therapies. The progress in anti-HER2 drugs includes the development of novel antibody-drug conjugates with improvements in the conjugation process and novel linkers and payloads. Moreover, trastuzumab deruxtecan has enhanced the efficacy of trastuzumab emtansine, and the new drug trastuzumab duocarmazine is currently undergoing clinical trials to assess its effect. The combination of anti-HER2 agents with other drugs is also being evaluated. The addition of immunotherapy checkpoint inhibitors shows some benefit in a subset of patients, indicating the need for useful biomarkers to properly stratify patients. Besides, CDK4/6 and tyrosine kinase inhibitors are also included in the design of new treatment strategies. Lapitinib, neratinib and tucatinib have been approved for HER2-positive metastasis patients, however clinical trials are currently ongoing to optimize combined strategies, to reduce toxicity, and to better define the useful setting. Clinical research should be strengthened along with the discovery and validation of new biomarkers, as well as a deeper understanding of drug resistance and action mechanisms.
RESUMEN
Diathermy techniques embody an oscillating electrical current passaging through the body tissues generating therapeutic heat; use of this technique in the physiotherapy field has been introduced recently, and because there is scarce information, the following review is proposed, aiming to explore the available evidence on applying CRET in physiotherapy clinical practice and sports. A systematic search was led through a keyword search on PubMed, MedLine, DialNet, Scopus, PEDro, Web of Science and Clinicaltrials databases. Including randomised controlled trials and quasi-experimental studies, which applied radiofrequency diathermy in sports and physiotherapy fields, without any restrictions on dates, published in Spanish, English, Portuguese or Italian. Data extraction was conducted through the Cochrane data extraction form and presented in tabular format; 30 articles were included for analysis, and assessment of methodological quality was made through the PEDro scale with a "Good/Fair" general quality score. The nature of existing articles does not allow a quantitative analysis. Conclusion: identified fields of applications were musculoskeletal physiotherapy, treatment of pelvic floor and sexual dysfunctions, as well as dermato-functional physiotherapy and sports, evidencing an increase of skin temperature, enhanced skin and muscle blood perfusion, as well as reporting an increase in oxyhaemoglobin. Further research is needed. Prospero registration number: CRD42020215592.
