Eficácia e segurança de trastuzumabe no tratamento de câncer de mama

PTC 04/2012

DOI: 10.13140/2.1.3630.9286

Autores: Adriana da Mata, Juliana Álvares, Augusto Afonso Guerra Júnior, Francisco de Assis Acurcio

RESUMO EXECUTIVO

Intensidade das recomendações: A1

Tecnologia: Trastuzumabe.

Indicação: Câncer de mama metastático com superexpressão de HER-2.

Caracterização da tecnologia: Trastuzumabe é um anticorpo monoclonal humanizado derivado de DNA recombinante, que se liga ao domínio extracelular do receptor do fator de crescimento epidérmico humano, HER-2. Esse anticorpo bloqueia o ligante natural e infra-regula o receptor. Sua utilização isolada ou em associação com quimioterápicos proporciona desaceleração na progressão do câncer de mama metastático HER-2 positivo.

Pergunta: O uso do trastuzumabe é eficaz e seguro no tratamento de câncer de mama metastático em mulheres com superexpressão de HER-2?

Busca e análise de evidências científicas: Foram pesquisadas as bases The Cochrane Library, Centre for Reviews and Dissemination (CRD), Tripdatabase, Medline via Pubmed e LILACS, objetivando-se encontrar revisões sistemáticas (RS) de ensaios clínicos que comparassem trastuzumabe a outras opções terapêuticas para o tratamento de câncer de mama metastático. Foram selecionados somente os estudos publicados em inglês, português ou espanhol.

Resumo dos resultados dos estudos selecionados: Foram selecionadas 9 RS. De maneira geral, as quimioterapias combinadas com trastuzumabe apresentam melhores resultados que a quimioterapia isolada, quanto a sobrevida global, sobrevida livre de doença e tempo de progressão da doença. Na RS que avalia a combinação do trastuzumabe com antraciclina verifica-se maior risco de disfunção cardíaca.

Recomendações: O uso de trastuzumabe em combinação com paclitaxel ou docetaxel como terapia de primeira linha para mulheres com câncer de mama metastático com superexpressão de HER-2 é recomendado.

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