| Abstract | U rad su uključeni pacijenti s HER-2 pozitivnim karcinomom dojke dijagnosticirani u Kliničkom bolničkom centru Zagreb tijekom 2016.godine. Tijekom analiziranog razdoblja nađeno je 65 uzoraka HER-2 pozitivnih tumora u 58(14%) pacijenata. Radilo se o jednom 63-godišnjem muškarcu, ostalo su bile žene (starosti 27-84 godine; medijan 55 godina). Uzorci su uključivali 29 iglenih biopsija dojke, jednu iglenu biopsiju limfnog čvora, 15 kirurških materijala tkiva dojke sa ili bez limfnih čvorova te 14 uzoraka udaljenih metastaza. 51,2% tumora je bilo Luminal B HER-2, a 48.8% HER-2 imunofenotipa.
Dodatni podaci bili su poznati za 46 pacijenata. U vrijeme dijagnoze, 18(40%) pacijenata je imalo lokaliziranu bolest, 15 (32%) uz pozitivne limfne čvorove, a 13(28%) je imalo udaljene metastaze. Luminal B HER-2+ tumori su bili češće gradusa 2 (90%), a čisti HER-2+ tumori gradusa 3(63%). Metastaze HER-2 pozitivnog karcinoma nađene su u limfnim čvorovima (16), jetri (11), kostima (8), mozgu (8), plućima (7), te rjeđe drugim lokacijama. Metastaze u mozak su češće nađene kod HER-2 pozitivnih karcinoma, a metastaze u kosti kod Luminal B HER-2+ tumora.
40 pacijenata je liječeno ciljanom anti-HER-2 terapijom (90% HER-2+ i 87% Luminal B HER-2+), a najčešće se koristio trastuzumab. U 14 pacijenata je trastuzumabu dodan pertuzumab, ili je kasnije zamijenjen drugim lijekovima (lapatinib, trastuzumab-emtansin i neratinib). Citotoksične lijekove je primalo 38 pacijenata, a najčešće su korišteni paclitaxel, docetaxel i kombinacija doxorubicina i ciklofosfamida. Dvanaest od 23 pacijenata s Luminal B HER-2+ tumorom je primalo i anti-hormsku terapiju, najčešće tamoxifen, letrozol ili anastrazol.
U periodu praćenja do zaključno s kolovozom 2020, 21 pacijentica nakon provedene terapije nije pokazala znakove recidiva bolesti. Sedam pacijentica je i dalje na ciljanoj terapiji, a 8 je preminulo u terminalnoj fazi bolesti. Devet je pacijentica izgubljeno iz praćenja, većina u uznapredovaloj ili terminalnoj fazi bolesti. Najbolje preživljenje uočeno je u grupi lokaliziranog karcinoma u vrijeme dijagnoze, a najlošije u grupi primarno metastatskog tumora. Uspoređujući metastatska sijela, najlošije preživljenje je nađeno u pacijentica s moždanim metastazama. |
| Abstract (english) | This study included patients with HER-2 positive breast cancer diagnostically evaluated in University Hospital Centre Zagreb during 2016. There were a total of 65 samples of HER-2 positive tumor from 58(14%) patients. One patient was a 63 year old male, and rest were females (age range 27-84; median 55 years) Samples included 29 breast core needle biopsies, one lymph node core biopsy, 15 surgical materials of breast tissue 14 distant metastases. Luminal B HER-2 positive cancer was diagnosed in 51.2% and HER-2 positive in 48.8% cases.
Additional data regarding stage and histology were available for 46 patients. At the time of diagnosis 18(40%) patients had localized disease,15 (32%) had regional lymph node metastases, and 13(28%) patients had systemic disease. Luminal B HER-2 positive tumors were more commonly grade 2(90%) and pure HER-2 positive cancer grade 3(63%). Metastatic sites with HER-2 positive cancer included regional lymph nodes (16), liver (11), bones (8), brain (8), lung (7), and others. Brain metastases were more common in pure HER-2 positive cancers, while bone metastases were more common in Luminal B HER-2 positive tumors.
40 patients received specific targeted anti-HER-2 therapy (90% HER-2+ and 87% Luminal B HER-2+), and trastuzumab was the most commonly administrated drug. In 14 patients trastuzumab was used with pertuzumab or replaced with lapatinib, trastuzumab-emtansine or neratinib. 38 patients received cytotoxic drugs, most commonly paclitaxel, docetaxel or combination of doxorubicine and cyclophosphamide. Twelve patients with Luminal B HER-2 positive tumor also received anti-hormonal therapy, in most cases tamoxifen, letrozol or anastrazol.
During follow-up period, 21 patients showed no signs of recurrent disease, 7 patients are still on targeted therapy, and 8 patients died from advanced disease. 9 patients were lost from follow-up, most in terminal stage of disease. The best survival were noted in group of patients with localized disease, and the poorest in group with primary systemic disease. Comparing to other metastatic sites, patients who developed brain metastases had the worst prognosis. |
