Aproximación amistosa al tratamiento personalizado del adenocarcinoma de pulmón.

A friendly approach to personalized treatment in lung adenocarcinoma.

Contenido principal del artículo

Rafael Rosell
Andrés Felipe Cardona
Rosario García Campelo
Margarita Majem
Enric Carcereny
Santiago Viteri
Amaya Gascó
Cristina Buges
Mariacarmela Santarpia
Jia Wei
Bartomeu Massuti
Carlota Costa
Miguel Ángel Molina

Resumen

El cáncer de pulmón es una enfermedad letal que en la mayoría de los casos se diagnostica en estado avanzado. En los adenocarcinomas se han identificado mutaciones conductoras en el dominio tirosina quinasa del receptor para el factor de crecimiento epidérmico (EGFR), especialmente en los nunca fumadores donde se han reportado entre el 20% y 60%. El tratamiento con inhibidores del EGFR (erlotinib o gefitinib) alcanza una respuesta global del 70% y una supervivencia libre de progresión (SLP) que oscila entre 9 y 13 meses, aunque algunos logran remisiones más prolongadas. También se ha identificado una mutación secundaria (T790M) que se relaciona con la resistencia adquirida, no obstante, puede estar presente de forma basal lo que podría indicar una enfermedad genéticamente distinta. Adicionalmente, se han descrito algunos modificadores génicos como el BRCA1 y los componentes de la vía de señalización del NFКB que podrían modular y predecir la respuesta a los inhibidores del EGFR. Un nuevo campo de investigación se abre para los genes que actúan como reguladores negativos de la expresión del BRCA1 lo que permitirá perfeccionar el modelo predictivo basado en la expresión del mARN del BRCA1. Aunque todavía no existe ninguna experiencia con la rebiopsia rutinaria al momento de la progresión clínica, esta intervención está garantizada para la mayoría de los pacientes con mutaciones del EGFR ya que es posible identificar múltiples cambios genéticos que pueden conducir a enfoques terapéuticos innovadores.

Detalles del artículo

Biografía del autor/a (VER)

Rafael Rosell, Hospital Germans Trias i Pujol

Catalan Institute of Oncology, Hospital Germans Trias i Pujol (Badalona, Spain). Pangaea Biotech, USP Dexeus University Institut (Barcelona, Spain)

Andrés Felipe Cardona, Fundación Santa Fe de Bogotá

Clinical and Translational Oncology Group, Institute of Oncology, Fundación Santa Fe de Bogotá (Bogotá, Colombia).  Foundation for Clinical and Applied Cancer Research (Ficmac); associated researcher ONCOLGroup.

Rosario García Campelo, Hospital Juan Canalejo

Hospital Juan Canalejo (La Coruña, Spain)

Margarita Majem, Hospital San Pau

Medical Oncology Department, Hospital San Pau (Barcelona, Spain)

Enric Carcereny, Hospital Germans Trias i Pujol

Catalan Institute of Oncology, Hospital Germans Trias i Pujol (Badalona, Spain).

Santiago Viteri, USP Dexeus University Institut

Pangaea Biotech, USP Dexeus University Institut (Barcelona, Spain)

Amaya Gascó, USP Dexeus University Institut

Pangaea Biotech, USP Dexeus University Institut (Barcelona, Spain)

Cristina Buges, Hospital Germans Trias i Pujol

Catalan Institute of Oncology, Hospital Germans Trias i Pujol (Badalona, Spain).

Mariacarmela Santarpia, University of Messina

Medical Oncology Department, University of Messina, Via Consolare Valeria (Messina, Italy)

Jia Wei, Medical School of Nanjing University

Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University (Nanjing, China).

Bartomeu Massuti, Hospital General Universitario de Alicante

Hospital General Universitario de Alicante (Alicante, Spain).

Carlota Costa, Hospital Germans Trias i Pujol

Catalan Institute of Oncology, Hospital Germans Trias i Pujol (Badalona, Spain).

Miguel Ángel Molina, Hospital Germans Trias i Pujol

Catalan Institute of Oncology, Hospital Germans Trias i Pujol (Badalona, Spain).

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