RESUMO
Considerable evidence supports the rationale for postoperative radiotherapy after breast cancer surgery. Moreover, local tumour control affects survival too. High-dose irradiation is inherently associated with an increased risk of secondary malignancies in the long run. This radiobiological phenomenon raises the question whether it is worth taking this hazard, and the exact level of the risk of a secondary malignancy should be clarified. Answering these questions is important, regarding the large population size of breast cancer survivors, as well as patients' improving survival rates and time. The postoperative radiation load to the ipsilateral lung tissue can be reduced, but it is still significant. The current literature review aims to evaluate the risk of secondary lung cancer associated with breast cancer- specific radiotherapy. Published evidence suggests that the benefits of postoperative radiotherapy following breast cancer surgery are much higher than the minimal risk of secondary lung cancer associated with this management strategy.
Assuntos
Neoplasias da Mama , Neoplasias Pulmonares , Segunda Neoplasia Primária , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Humanos , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/radioterapia , Mastectomia , SobrepesoRESUMO
At present an estimated hundred millions of women worldwide use oral contraception, but the influence of hormonal contraception on carcinogenesis of breast is not fully understood. Previous studies of breast cancer risk show inconsistent findings - from zero elevation to approximately 30%-40% increase in risk. The beneficial effect on ovarian and endometrial cancer risk is apparent. In this literature review we attempt to determine effects of oral contraception in relation to the risk of breast cancer. The risk increased with longer duration of use, but absolute increase is very small. "Beneficial effects of OCs on the gynecological cancers thus outweighed adverse effects." (Vessey).
Assuntos
Neoplasias da Mama/induzido quimicamente , Neoplasias da Mama/epidemiologia , Anticoncepcionais Orais/efeitos adversos , Adulto , Distribuição por Idade , Idoso , Neoplasias da Mama/patologia , Anticoncepcionais Orais/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Hungria , Pessoa de Meia-Idade , Prevalência , Prognóstico , Medição de RiscoRESUMO
Regular consumption of alcohol increases the risk of developing (one or more of) several malignant conditions: the frequency of tumours in the aerodigestive tract, in the liver, in the colorectal region and in the breast is increased. The principal carcinogen component of alcoholic drinks is ethanol itself; the effect is unmistakably proportional to the daily/weekly dosage. Under the influence of alcohol-dehydrogenase, ethanol will metabolise to acetaldehyde, which is a known carcinogen. Among other things chronic alcohol consumption promotes the production of endogen hormones, affects the insulin-like growth factor-1, alters several biological pathways, raises oxidative stress, and damages the genes. Even modest daily alcohol intake will increase the risk of breast cancer.
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Neoplasias da Mama/induzido quimicamente , Etanol/efeitos adversos , Acetaldeído/metabolismo , Álcool Desidrogenase/metabolismo , Neoplasias da Mama/genética , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinógenos/administração & dosagem , Dano ao DNA , Etanol/administração & dosagem , Humanos , Estresse Oxidativo/efeitos dos fármacosRESUMO
With the continually growing number of cancer survivors in the past decades there is an increased interest in understanding and treating the adverse events of cancer therapy, which damage the survivor's quality of life. Post-treatment cognitive impairment (chemobrain) is well known in women with breast cancer and other patients with malignancy. The goal of the current short review is to arouse the caregivers' attention to the not severe, but real problem.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/psicologia , Disfunção Cognitiva/induzido quimicamente , Qualidade de Vida , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante/efeitos adversos , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Feminino , Humanos , Hungria , Incidência , Pessoa de Meia-Idade , Medição de Risco , Sobreviventes , Fatores de TempoRESUMO
Some disseminated tumor cells (as "seeds") feel well in the skeletal tissue, as a "soil", but the humoral crosstalk between tumor cells and bone cells disrupts the normal bone homeostasis (remodeling), which leads to a vicious circle, the multiple bone metastatic disease. The tumor cells could stimulate bone resorption, bone neo-formation or both, characteristic of the primary tumor. This usually incurable condition involves serious consequences, as fractures, pain, surgeries, irradiations, plegias, hypercalcemia, etc. (skeletal-related events, SREs), which destroy the quality of life. Targeting bone resorption with bisphosphonates or RANK ligand dependent mechanism could improve the rate of serious SREs and disease-free survival.
Assuntos
Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Denosumab/uso terapêutico , Difosfonatos/uso terapêutico , Medição da Dor , Ligante RANK/sangue , Administração Oral , Neoplasias Ósseas/mortalidade , Humanos , Hungria , Invasividade Neoplásica , Metástase Neoplásica/tratamento farmacológico , Estadiamento de Neoplasias , Manejo da Dor , Prognóstico , Ligante RANK/efeitos dos fármacos , Medição de Risco , Análise de Sobrevida , Resultado do TratamentoRESUMO
About 50% of all patients with cancer eventually develop anorexia/cachexia syndrome, which represents a complex clinical syndrome occurring in several illnesses, including cancer. The syndrome is characterized by systemic inflammation and primarily loss of body fat and body mass. In this review we shortly summarize the pathomechanism of anorexia/cachexia syndrome and list the current pharmacological approaches.
Assuntos
Anorexia/epidemiologia , Caquexia/epidemiologia , Neoplasias/complicações , Anorexia/etiologia , Anorexia/terapia , Caquexia/etiologia , Caquexia/terapia , Humanos , Neoplasias/tratamento farmacológico , SíndromeRESUMO
Endocrine agents are well established standards of care in hormone-sensitive postmenopausal breast cancer. The pure estrogen receptor antagonist (down-regulator) fulvestrant after binding to the ER induces its conformational change which disrupts ER signal and accelerates ER degradation. Fulvestrant is devoid of partial agonist activity. In unselected patients there was no difference in TTP between "standard dose" fulvestrant and aromatase inhibitors, but in first-line treatment of advanced breast cancer the elevated dose of fulvestrant may delay progression and may extend the overall survival compared with aromatase inhibitors.
Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Estradiol/análogos & derivados , Antagonistas do Receptor de Estrogênio/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/mortalidade , Intervalo Livre de Doença , Esquema de Medicação , Estradiol/administração & dosagem , Estradiol/uso terapêutico , Antagonistas do Receptor de Estrogênio/administração & dosagem , Feminino , Fulvestranto , Humanos , Pós-Menopausa , Análise de SobrevidaRESUMO
The active form of vitamin D, in conjunction with his own receptor, affect a multitude of biological processes in the cell (inter alia it influences the expression of oncogenes and tumor suppressor genes). There is an increasing volume of scientific publications examining the relationships between serum vitamin D levels, vitamin D supplementation and malignant diseases. Some articles suggest inverse relationship between the low serum levels of vitamin D and the breast cancer risk and mortality, whilst other publications do not support this view. Thus the present opinion is conflicted. Vitamin D can exert a beneficial influence on the symptoms and outcomes of a large number of ailments, but its role in affecting cancer is still not completely clear.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/prevenção & controle , Suplementos Nutricionais , Vitamina D/sangue , Vitamina D/uso terapêutico , Neoplasias da Mama/sangue , Neoplasias da Mama/etiologia , Neoplasias da Mama/mortalidade , Feminino , Genes Supressores de Tumor/efeitos dos fármacos , Humanos , Oncogenes/efeitos dos fármacos , Fatores de Risco , Vitamina D/farmacologia , Deficiência de Vitamina D/complicações , Vitaminas/sangue , Vitaminas/uso terapêuticoRESUMO
Cardiac complications may present a particular problem following radiation treatment applied to the mediastinum and thoracic wall (and especially to the left breast). Exposure of the heart during radiotherapy increases the risk of ischemic heart disease occurring generally years after the treatment. The incidence of radiation cardiotoxicity depends on various factors related to oncological therapies and the patient (details of radiotherapy, age, gender, comorbidities, smoking habits, etc.). Until recently the majority of clinical studies reported increased cardiac morbidity in patients receiving radiation treatment of the chest wall and the breast. Due to modern methods, however, postoperative chest wall and left breast irradiation is much safer today than previously. In order to avoid cardiotoxicity, adherence to clinical practice guidelines for chemo- and targeted therapy of breast cancer, use of the most advanced irradiation procedures, regular monitoring of patients, and close cooperation between cardiologists and oncologists are all recommended.
Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Coração/efeitos da radiação , Isquemia Miocárdica/etiologia , Lesões por Radiação/complicações , Radioterapia Adjuvante/efeitos adversos , Cardiologia , Feminino , Humanos , Comunicação Interdisciplinar , Mastectomia Segmentar , Oncologia , Período Pós-Operatório , Lesões por Radiação/etiologiaRESUMO
The skeleton is the most common site to be affected by advanced breast, prostatic, lung, kidney, thyroid and other solid tumors (in addition to myeloma multiplex). Bone metastases cause significant morbidity with nearly always fatal outcome. Over 600 000 new patients diagnosed in the developed countries yearly. On average every 4-6 months patients suffer from series of severe skeletal complications such as pathologic fractures, spinal cord compression, hypercalcemic events, etc., besides the permanent pain. Local external beam radiotherapy, systemic radioisotope-, endocrine-, and chemotherapy, oral and i.v. bisphosphonates and recently s.c. denosumab are the mainstays of treatment, in addition to pain-killers and other usual "classical" interventions. The modern treatments singificantly reduce the probability of skeletal complications and improve the patients' quality of life and, sometimes, they extend the survival as well. The authors briefly summarize the available treatment options.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Difosfonatos/uso terapêutico , Radioisótopos/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/complicações , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/radioterapia , Neoplasias da Mama/patologia , Denosumab , Fracionamento da Dose de Radiação , Feminino , Humanos , Hipercalcemia/tratamento farmacológico , Hipercalcemia/etiologia , Neoplasias Pulmonares/patologia , Masculino , Mieloma Múltiplo/patologia , Neoplasias da Próstata/patologia , Neoplasias Urológicas/patologiaRESUMO
In several large adjuvant clinical trials it has been demonstrated that substitution (eventually addition) of aromatase inhibitors (AIs) provides an improved outcome of endocrine-sensitive breast cancer over tamoxifen alone. Nevertheless, arthralgia induced by the AIs is one of the most frequent side effects in hormonal therapy. It is characterized by tenosynovial changes and is more frequent in patients in clinical practice than previously appreciated in adjuvant clinical trials. AI-related arthralgia may be related to estrogen deprivation, but estrogen replacement is not an option for these women. Therefore standard painkillers, NSAIDs (COX2 inhibitors), week opioids and other interventions (vitamin D, calcium, bisphosphonates, exercise, acupuncture, complementary and alternative approaches, eventually switch to another endocrine drug) are used for managing this treatment-related side effect, and improve adherence and quality of life among breast cancer survivors.
Assuntos
Antineoplásicos Hormonais/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Artralgia/induzido quimicamente , Artralgia/terapia , Neoplasias da Mama/tratamento farmacológico , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Anastrozol , Androstadienos/efeitos adversos , Antineoplásicos Hormonais/administração & dosagem , Inibidores da Aromatase/administração & dosagem , Quimioterapia Adjuvante , Ensaios Clínicos como Assunto , Feminino , Humanos , Letrozol , Adesão à Medicação , Nitrilas/efeitos adversos , Pós-Menopausa , Qualidade de Vida , Fatores de Risco , Triazóis/efeitos adversosRESUMO
Anthracyclines have probably been considered to be the most active agents for the treatment of breast cancer and some other solid tumors and hematological malignancies. However, they are associated with dose-related cardiotoxicity, which can lead to progressive myocardial damage and limits the maximal cumulative dose that can be given. This review focuses on the non-pegylated liposome-encapsulated doxorubicin (Myocet®), which has been developed to increase the therapeutic index of free doxorubicin. The encapsulation of doxorubicin within a macromolecular vector, such as a liposome ("nanoparticle based drug delivery system") reduces its distribution volume, diminishing its toxicity for healthy tissues while increasing the concentration within the neoplastic tissue. The most common adverse event is neutropenia, which is consistent with previous experience with free doxorubicin. Available evidence suggests that the incidence of hematological toxicity is lower than with conventional doxorubicin. Myocet® both as a single agent and in combination is effective and safe with an associated reduction in incidence and severity of cardiac events. Nagykálnai T. Non-pegylated doxorubicin (Myocet®) as the less cardiotoxic alternative of free doxorubicin.
Assuntos
Antibióticos Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Doxorrubicina/efeitos adversos , Cardiopatias/induzido quimicamente , Cardiopatias/prevenção & controle , Antibióticos Antineoplásicos/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante , Ensaios Clínicos como Assunto , Docetaxel , Doxorrubicina/administração & dosagem , Humanos , Neoplasias/tratamento farmacológico , Paclitaxel/administração & dosagem , Taxoides/administração & dosagem , TrastuzumabRESUMO
Chemotherapy options of metastatic colorectal cancer (mCRC) have been progressed rapidly in the last years. Besides of the standard fluorouracil/folinic acid treatment some new active agents (oxaliplatin and irinotecan) have been introduced, and more recently the "targeted" biologicals (bevacizumab, cetuximab, panitumumab) have demonstrated their high effectiveness. This review summarizes the development of the first line treatment of mCRC.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Administração Oral , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Capecitabina , Cetuximab , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Esquema de Medicação , Receptores ErbB/antagonistas & inibidores , Fluoruracila/administração & dosagem , Fluoruracila/análogos & derivados , Humanos , Irinotecano , Leucovorina/administração & dosagem , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Oxaloacetatos , Panitumumabe , Medicina de Precisão , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Resultado do TratamentoRESUMO
Elderly patients will be the largest group of oncology patients in the future. Because of minimal participation of older patients in randomized clinical trials there is a lack of evidence-based data to make correct decisions with regard to chemotherapy and/or targeted therapy in this age group. Elderly patients have similar benefits from systemic therapies as younger counterparts, but many elders have substantial co-morbidities, which may limit the life expectancy and the effectiveness of systemic therapy. Close collaboration between oncologists and geriatrists will help make decisions on the management of elderly patients suffering from cancer.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab , Camptotecina/análogos & derivados , Camptotecina/uso terapêutico , Capecitabina , Cetuximab , Quimioterapia Adjuvante , Neoplasias Colorretais/patologia , Comorbidade , Comportamento Cooperativo , Tomada de Decisões , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Fluoruracila/análogos & derivados , Fluoruracila/uso terapêutico , Humanos , Irinotecano , Expectativa de Vida , Compostos Organoplatínicos/uso terapêutico , Oxaliplatina , Equipe de Assistência ao PacienteRESUMO
From the big randomized clinical trials there are evidences that adjuvant endocrine therapy for hormone-sensitive early breast cancer in postmenopausal women should include an aromatase inhibitor (AI). Anastrozole or letrozole should be used upfront for 5 years (ATAC and BIG 1-98), the sequential approach of tamoxifen for 2-3 years, followed by anastrozole or exemestane for 2-3 years is a reasonable alternative (ABCSG8, ARNO 95, IES, ITA), and mostly in patients with node-positive disease completing 5 years of tamoxifen should be offered letrozole up to 4-5 years (MA-17). In each of these trials incorporation of an AI resulted in significant improvement in study endpoints. Further results will be needed to establish the optimal beneficial effect, use, duration and safety of adjuvant AI therapies.
Assuntos
Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Moduladores de Receptor Estrogênico/administração & dosagem , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Pós-Menopausa , Idoso , Anastrozol , Androstadienos/administração & dosagem , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Quimioterapia Adjuvante , Esquema de Medicação , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Letrozol , Metástase Linfática/prevenção & controle , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Neoplasias Hormônio-Dependentes/metabolismo , Nitrilas/administração & dosagem , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Moduladores Seletivos de Receptor Estrogênico/administração & dosagem , Tamoxifeno/administração & dosagem , Resultado do Tratamento , Triazóis/administração & dosagemRESUMO
The aim of our study was to compare the applicability of the conventional echocardiography and a novel method, tissue Doppler imaging (TDI) in detection of late or subclinical cardiotoxicity following anthracycline chemotherapy in long-term follow up. Forty women (31 to 65 years) were enrolled, who had not received anthracyclines previously and had normal cardiac function. The control group consisted of 20 healthy persons of similar age range. In addition to standard echocardiographic measurements, each patient underwent specific measurements (E-septum separation, pulmonary venous flow) as well. Furthermore, the myocardial velocity of numerous segments of the mitral anulus obtained with pulsed wave TDI was also detected over a two-year-long period. Systolic left ventricular function did not change significantly either in the study or in the control group. After one year, diastolic left ventricular function was impaired in 39 patients (97.5%), and 29 (72.5%) of these showed clear changes by means of the traditional E/A ratio and TDI. However, in ten patients (25%) the diastolic dysfunction could only be detected with TDI. At the end of the study diastolic dysfunction was detected in each patient, but in 13 patients (32.5%) the relaxation disorder could be revealed only with TDI. Detectable myocardial damage occurred in the study group as a result of anthracycline therapy. Our results confirmed our assumptions that TDI is a more precise and useful examination method than the traditional ones (E/A ratio or deceleration time) to demonstrate isolated diastolic dysfunction. TDI may become a regularly and more widely used noninvasive method to detect subclinical cardiotoxicity emerging after chemotherapy.
Assuntos
Antraciclinas/efeitos adversos , Antibióticos Antineoplásicos/efeitos adversos , Cardiomiopatias/induzido quimicamente , Ecocardiografia Doppler , Adulto , Idoso , Antraciclinas/uso terapêutico , Antibióticos Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Cardiomiopatias/diagnóstico , Diagnóstico Precoce , Ecocardiografia , Feminino , Seguimentos , Coração/fisiopatologia , Humanos , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Disfunção Ventricular Esquerda/diagnósticoRESUMO
Intravenous ibandronate at a dose of 6 mg every 3-4 weeks in patients with breast cancer and bone metastases produced a significant, 40% reduction in the relative risk of skeletal-related events. Oral ibandronate at a dose of 50 mg once daily for 96 weeks similarly reduced the overall skeletal morbidity, equating to a reduction in the relative risk of skeletal-related events of 38% relative to placebo. Ibandronate was generally well tolerated in clinical trials and their long-term extensions. Both type of administration significantly improve patients' health-related quality of life. There was no evidence of renal toxicity with iv. or oral ibandronate.
Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Difosfonatos/uso terapêutico , Administração Oral , Conservadores da Densidade Óssea/administração & dosagem , Neoplasias da Mama/patologia , Difosfonatos/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Ácido Ibandrônico , Infusões Intravenosas , Oncologia/métodos , Qualidade de VidaRESUMO
The authors give a brief summary about the process and significance of cardiotoxicity produced by chemotherapy and irradiation used for malignancy. After the introduction, those invasive and noninvasive processes are put into focus and explained in detail, which are applied in the research of the effects of cardiotoxic chemotherapy. The clinical importance of this research is the life prolongation effect of the treatment, which allows the late-appearing toxic cardiomyopathy, resulting in congestive heart failure and increasing mortality. Summarizing the last decade's progress in research, it is evident that even in the planning of chemotherapy, the cardiovascular risks have to be taken into account, because they can greatly influence the cardiac side effect of the treatment.
Assuntos
Antineoplásicos/efeitos adversos , Cardiomiopatias/induzido quimicamente , Cardiomiopatias/diagnóstico , Antineoplásicos/administração & dosagem , Fator Natriurético Atrial/metabolismo , Biomarcadores/metabolismo , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/metabolismo , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Diástole , Eletrocardiografia , Insuficiência Cardíaca/induzido quimicamente , Insuficiência Cardíaca/diagnóstico , Frequência Cardíaca/efeitos dos fármacos , Humanos , Imageamento por Ressonância Magnética , Peptídeo Natriurético Encefálico/metabolismo , Ventriculografia com Radionuclídeos , Sístole , Função Ventricular Esquerda/efeitos dos fármacosRESUMO
Bone metastases afflict over 70% of patients with advanced breast cancer, resulting in impaired quality of life and significant clinical problems. Until appearance of the bisphosphonates there was no specific therapeutic treatment available to manage the symptoms of osteolytic bone metastases. Bisphosphonates are stable chemical analogues of pyrophosphate, and inhibit osteoclast-mediated bone resorption, the treatment is effective in reducing skeletal morbidity in breast cancer with fewer skeletal related events, reduced pain and analgesic consumption, and improved quality of life. As a result, bisphosphonates should now be part of the routine management of metastatic bone disease and multiple myeloma. Promising data have resulted in considerable interest in the possible adjuvant use of bisphosphonates. Pamidronate is an easy to use potent inhibitor of osteolysis, given in conjunction with standard anticancer therapies effectively relieves bone pain and improves performance status. Monthly pamidronate infusions for one or two years in addition to standard anticancer therapy reduce by more than one third the yearly frequency of skeletal-related events. The authors report their practice in which 119 breast cancer patients metastatic to bone received 90-120 mg pamidronate infusion/cycle in addition to standard breast cancer therapy every 3-4 weeks.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Difosfonatos/uso terapêutico , Assistência Ambulatorial , Animais , Antineoplásicos/administração & dosagem , Antineoplásicos/economia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/economia , Neoplasias da Mama/economia , Difosfonatos/administração & dosagem , Difosfonatos/economia , Esquema de Medicação , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Infusões Intravenosas , Dor/etiologia , Dor/prevenção & controle , Pamidronato , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Selective estrogen receptor modulators (SERMs) represent a growing class of compounds that act as either estrogen receptor gonists or ntagonists in tissue-selective manner. SERMs with the appropriate selectivity profile offer the opportunity to dissociate the favorable bone and cardio-vascular effects of estrogen from its unfavorable stimulatory effects on the breast and uterus. The triphenylethylene drug tamoxifen proved to be invaluable to treat and protect against breast cancer and bone loss, probably reduces cardiovascular risk, but had side effects on uterus similar to natural estrogens. The tamoxifen derivate toremifene is also used to treat breast cancer, but has less effect on bone. The non-steroidal benzothiophene derivate, raloxifene, is the best SERM available thus far. It has the potential to prevent breast cancer (like tamoxifen), but has better profile in its actions on bone and cardiovascular system (produces a rapid reduction of serum cholesterol, decreases fibrinogen and lipoprotein, improves the vascular epithelial function, attenuates vascular intimal thickening, etc.). It does not increase the incidence of endometrial cancer. Compounds of this class are the first step in developing the perfect hormone replacement and other multitargeted therapy. This review summarizes the recent important knowledge about SERMs.