| Popis: |
HER2 pozitivni karcinoma dojke posebno je agresivan oblik povezan s bržom progresijom bolesti i kraćim preživljavanjem ukoliko se bolest ne liječi. Ovaj je tip karcinoma karakteriziran prekomjernom proizvodnjom HER2 proteina koji potiče brži rast i diobu stanica raka. Odluka o liječenju donosi se na temelju karakteristika tumora, stadija bolesti i obilježja bolesnika te njegovim željama i potrebama. U ovom radu nalazi se pregled odobrenih terapijskih opcija liječenja HER2 pozitivnog tumora, kao i novih terapijskih mogućnosti koje se trenutno nalaze u fazama istraživanja. Za većinu pacijenata kemoterapija u kombinaciji s trastuzumabom i pertuzumabom predstavlja prvu liniju liječenja nakon čega slijedi trastuzumab emtanzin kao druga linija. Međutim, kod odabranih pacijenata se anti HER2 terapija bez kemoterapije također može razmotriti kao izbor. Kao treća linija i dalje je dostupno nekoliko novih anti-HER2 terapija, uključujući tukatinib, neratinib, trastuzumab-deruksetan i margetuksimab. Osim toga, novi lijekovi i kombinacije koji su trenutno u fazi ispitivanja pokazuju obećavajuće rezultate, iako je ljestvica za poboljšanje ukupnog preživljavanja (eng. Overall survival, OS) novim agensima vrlo visoka i izazovna. HER2- positive breast cancer is a particularly aggressive form associated with faster disease progression and shorter survival rate if the disease is not treated. This type of cancer is characterized by excessive production of the HER2 protein, which promotes faster growth and division of cancer cells. The decision on treatment is made based on the characteristics of the tumor, the stage of the disease and the characteristics of the patient, as well as on their wishes and needs. This thesis contains an overview of approved therapeutic options for the treatment of HER2- positive tumors, as well as new therapeutical options that are currently in research phases. For most patients, chemotherapy in combination with trastuzumab and pertuzumab is the first- line treatment followed by trastuzumab emtansine as the second-line treatment. However, in selected patients, anti-HER2 therapy without chemotherapy can also be considered as an option. Several new anti-HER2 therapies remain available as the third-line, including tucatinib, neratinib, trastuzumab-deruxetan and margetuximab. In addition, new drugs and combinations currently under investigation show promising results, although the bar for improving overall survival (OS) with new agents is very high and challenging. |
