RESUMO
In the randomized phase 2 study there was evaluated the efficacy of neoadjuvant endocrine treatment (anastrozole, exemestane) in comparison with chemotherapy (doxorubicin plus paclitaxel). Preoperative endocrine therapy was well tolerated. There was a trend towards higher overall rates of objective response and breast conserving surgery (BCS) among patients with tumors expressing high levels of ER (luminal A) in endocrine therapy group compared with chemotherapy group (43% vs 24%; p = 0,054). In HER2-positive breast cancer patients the addition of trastuzumab to neoadjuvant chemotherapy improved the overall and pathological complete response. Trastuzumab made possible an increasing number of breast conserving surgery (23% vs 13%; p = 0,022). No patient treated with trastuzumab and with chemotherapy had a local recurrence after BCS.
Assuntos
Antineoplásicos Hormonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Mastectomia Segmentar , Terapia Neoadjuvante/métodos , Adulto , Idoso , Anastrozol , Androstadienos/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Neoplasias da Mama/química , Doxorrubicina/administração & dosagem , Everolimo , Feminino , Humanos , Mastectomia Segmentar/estatística & dados numéricos , Pessoa de Meia-Idade , Nitrilas/administração & dosagem , Paclitaxel/administração & dosagem , Pós-Menopausa , Receptor ErbB-2/análise , Receptores de Estrogênio/análise , Sirolimo/administração & dosagem , Sirolimo/análogos & derivados , Serina-Treonina Quinases TOR/antagonistas & inibidores , Trastuzumab , Resultado do Tratamento , Triazóis/administração & dosagemRESUMO
Cancer stem cells (CSCs) possess self-renewal and heterogeneous cancer cell lines formation. Numerous data confirm the existence of a model in which CSCs have an important role in cancer initiation, progression and clinical outcome. Analysis of CSCs role in metastasis, in contrast, remains mainly conceptual and hypothetical. Recent data are summarized in this review which support the CSCs theory as a source of breast cancer metastatic lesions with noting the key role of the microenvironment.
