Utjecaj analoga gonadotropina na prevalenciju i intenzitet nuspojava adjuvantne endokrine terapije u premenopauzalnih žena koje su preboljele hormon ovisni rani rak dojke

master's thesis

• Title (english): Effect of gonadotropin analogues on the prevalence and intensity of side effects of adjuvant endocrine therapy in premenopausal women suffering from early stage hormone receptor positive breast cancer
• Author: Marcela Bibić
• Mentor: Iva Mucalo (mentor)
• Committee member: Iva Mucalo (predsjednik povjerenstva)
• Committee member: Tajana Silovski (član povjerenstva)
• Committee member: Andrea Brajković (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2023-07-20, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Karcinom dojke najčešće je dijagnosticiran karcinom u žena, te se na godišnjoj razini u Hrvatskoj dijagnosticira 2300
novih slučajeva raka dojke. Oko 20% dijagnosticiranih slučajeva odnose se na HR+ karcinom dojke, u čijem se liječenju
koristi adjuvantna antiestrogenska terapija SERM-ovima (tamoksifen) i AI (eksemestan, anastrozol, letrozol), a kod
predmenopauzalnih žena toj se terapiji nadodaje i liječenje analozima gonadotropina kao što su goserelin, triptorelin ili
leuprorelin.
Cilj ovog diplomskog rada bio je istražiti utjecaj analoga GnRH-a na težinu i prevalenciju nuspojava adjuvantne
endokrine terapije kod premenopauzalnih žena s preboljenim ranim karcinomom dojke.
Ovaj rad dio je presječnog i opservacijskog istraživanja ˝ Čimbenici koji utječu na adherenciju pri adjuvantnom
endokrinom liječenju žena s ranim rakom dojke u Hrvatskoj˝ , te se provodio u Ambulanti za bolesti dojke u Kliničkom
bolničkom centru Zagreb u razdoblju od studenog 2022. do veljače 2023. godine.
Težina nuspojava u zadnih tjedan dana procjenjivala se korištenjem FACT-ES upitnika, koji je sadržavao tvrdnje vezane
za tjelesno zdravlje, emocionalne simptome, društvene odnose te intenzitet očekivanih nuspojava antiestrogenske
terapije. Upitnik su ispitanice ispunjavale samostalno ili uz pomoć ispitivača.
U istraživanju je sudjelovalo 413 ispitanica prosječne dobi od 45 godina te ih je većina bila udana ili u izvanbračnoj
zajednici, zaposlena na puno radno vrijeme i visoko obrazovana.Rezultati upitnika ukazali su na to da dodatna terapija
analozima gonadotropina uz tamoksifen ili ihibitor aromataze uzrokuje teže i češće nuspojave u usporedbi s terapijom
koja se sastoji samo od tamoksifena ili AI-a, stoga su žene koje pripadaju skupini koja uz tamoksifen ili AI prima i
analoge gonadotropina u gotovo svim slučajevima iskusile učestalije i izraženije vazomotorne, gastrointestinalne,
kognitivne i ginekološke nuspojave.
Uzimajući u obzir da neke od istraživanih nuspojava značajno smanjuju kvalitetu života te da su nuspojave najčešći
uzrok neadherencije kod oboljelih od karcinoma dojke, ovakvi rezultati ukazuju na potrebu za promjenom pristupa
liječenju. To se pogotovo odnosi na mlađe i predmenopauzalne žene koje su primorane uzimati analoge GnRH-a zbog
suprimiranja funkcije ovarija, te bi se takvim pacijenticama boljom podnošljivosti terapije uvelike ulakšalo uzimanje
terapije kroz cijeli predviđeni period adjuvantnog liječenja. Istraživanje ovog tipa na ženama koje su preboljele karcinom
dojke te primaju adjuvantnu endokrinu terapiji prvi je put provedeno u Hrvatskoj te može doprinijeti razumijevanju
utjecaja kojeg analozi gonadotropina imaju na težinu nuspojava adjuvantne endokrine terapije, što je bitno kako bi se
smanjili neželjeni simptomi endokrine terapije te optimizirala farmaceutska skrb usmjerena na oboljele od karcinoma
dojke.

Abstract (english)

Breast cancer is the most diagnosed cancer worldwide, with 2300 new cases of breast cancer being diagnosed in Croatia
each year. HR positive breast cancer represents around 20 % of all diagnosed cases, while the most used treatments for
this cancer type include SERMs (tamoxifene) and AIs (exemestane, letrozole, anastrozole), which are accompanied by
GnRH agonists (gosereline, triptoreline, leuproreline) in regards to treating pre-menopausal women.
The goal of this thesis was to examine the effects of GnRH agonists on the prevalence and intensity of adjuvant endocrine
therapy side-effects.
The thesis is a part of a cross-sectional and observational study ˝Factors that influence adherence to adjuvant endocrine
therapy of women with early breast cancer in Croatia˝. which was carried out in the Clinical hospital center Zagreb from
November 2022 to February 2023. The severity of side effects in the last week was evaluated with the help of the FACTES
questionnaire, which contained statements regarding physical health, emotional simptoms, social relationships and
the intensity of expected side effect of adjuvant endocrine treatment.The participants filled out the forms themselves or
with the help of the research assistants.
413 women, aged 45 on average, participated in this study. Most of them were married, working full-time jobs and
highly educated.
This study showed that the women who received gonadotropin analogues in conjuntion with tamoxifene or AIs reported
stronger and more frequent vasomotor, cognitive, gastrointestinal and gynecological side effects than women who only
had tamoxifene or AIs as their adjuvant therapy. Considering that some of these side affects dramatically alter the quality
of life, as well as the fact that adverse effects represent the main cause of non adherence, these results point to a need
for modifying the approach to therapy of breast cancer patients.This is especially true for younger and pre-menopausal
women, who have to take GnRH agonists and who would benefit greatly from better tolerability of the medications,
which would allow them to take the medication throughout the entire intended duration of the adjuvant endocrine
therapy.This is the first time that this type of study on breast cancer patients is being conducted in Croatia. It may
contribute to the understaning of the effects that gonadotropin analogues have on the intensity of adjuvant endocrine
therapy side effects, so that the unwanted side effects can be reduced and the pharmaceutical care of breast cancer
patients could be optimised.

• Keywords: hormon ovisan karcinom dojke; analozi gonadotropina; adjuvantna endokrina terapija
• Keywords (english): hormone dependent breast cancer; gonadotropin analogues; adjuvant endocrine therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:163:747384
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-03-04 12:55:32