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Avanços terapêuticos na abordagem do Linfoma de Hodgkin
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O Linfoma de Hodgkin (LH) é uma neoplasia hematolinfoide rara que constitui cerca de 0,2% dos novos casos de cancros a nível mundial, sendo mais comum nos jovens adultos entre os 20-34 anos, representando a doença oncológica mais recorrente nesta faixa etária.
A patologia divide-se em dois grupos, o Linfoma de Hodgkin Clássico (LHC), que se encontra subdividido em quatro histologias e o Linfoma de Hodgkin Nodular de Predomínio Linfocitário (LHNPL), correspondendo a cerca de 90% e 10% dos casos reportados, respetivamente. Estas duas apresentações da doença distinguem-se pela presença de células características de cada uma, como as células de Reed-Sternberg no LHC, e as células predominantemente linfocíticas no LHNPL.
O diagnóstico patológico do LH é realizado, preferencialmente, através da biópsia excisional e avaliação imunohistoquímica. O correto diagnóstico, estadiamento baseado na classificação de Ann Arbor e avaliação de fatores de risco são fundamentais para a escolha de um tratamento correto.
Atualmente, a tomografia por emissão de positrões com tomografia computorizada é a técnica imagiológica (PET/CT) mais importante na avaliação da doença. Este exame complementar permite avaliar a resposta à terapêutica através de um re-estadiamento. Mediante esta abordagem permite-se realizar uma terapêutica personalizada e dirigida à resposta dos doentes.
A terapêutica do LH recorre maioritariamente ao regime combinado de radioterapia e quimioterapia, destacando-se os protocolos ABVD e BEACOPPesc. Com uma abordagem mediada pela resposta ao tratamento com a utilização da PET/CT, o LH é atualmente uma das doenças oncológicas com maiores taxas de sucesso, apresentando como o seu objetivo terapêutico final a cura da doença.
No entanto, apesar da terapêutica clássica combinada apresentar ótimos resultados, 10% a 30% dos doentes apresentam recidiva ou são refratários ao tratamento. Existe assim uma necessidade de estender o arsenal terapêutico de modo a dar resposta a estes doentes.
Surgem assim as novas abordagens terapêuticas, não só no âmbito de novos fármacos, mas também na otimização das terapêuticas já existentes e em combinação com estas novas alternativas terapêuticas. Destacam-se assim as abordagens maioritariamente pertencentes à terapêutica dirigida como conjugados anticorpo-fármaco, inibidores dos checkpoints imunitários, inibidores das vias de sinalização oncogénicas e imunomoduladores, já implementadas na prática clínica.
Hodgkin's Lymphoma (HL) is a rare hematolymphoid neoplasm that accounts for approximately 0.2% of new cancer cases worldwide, being more common in young adults between the ages of 20-34 years. It represents the most recurring oncological disease in this age group. The pathology is divided into two groups: Classic Hodgkin Lymphoma (CHL), which is further subdivided into four histologies, and Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL), accounting for approximately 90% and 10% of the reported cases, respectively. These two disease presentations are distinguished by the presence of characteristic cells, such as Reed-Sternberg cells in CHL and predominantly lymphocytic cells in NLPHL. The pathological diagnosis of HL is preferably performed through excisional biopsy and immunohistochemical evaluation. The accurate diagnosis, staging based on the Ann Arbor classification, and evaluation of risk factors are essential for choosing the correct treatment. Currently, positron emission tomography with computed tomography (PET/CT) is the most important imaging technique for assessing the disease. This complementary examination allows for evaluating the response to therapy through restaging. This approach enables personalized and response-directed treatment for patients. The therapy for HL mainly involves a combined regimen of radiation therapy and chemotherapy, with ABVD and BEACOPPesc being the most used protocols. With an approach guided by treatment response using PET/CT, HL is currently one of the oncological diseases with the highest success rates, aiming for disease cure as the ultimate therapeutic goal. However, despite the excellent results of the combined classical therapy, 10% to 30% of patients experience relapse or are refractory to treatment. Therefore, there is a need to expand the therapeutic arsenal in order to provide a response for these patients. New therapeutic approaches emerge, not only in terms of new drugs but also in the optimization of existing therapies and in combination with these new therapeutic alternatives. Notable approaches include those mainly belonging to targeted therapy, such as antibody-drug conjugates, immune checkpoint inhibitors, inhibitors of oncogenic signaling pathways, and immunomodulators, which have already been implemented in clinical practice.
Hodgkin's Lymphoma (HL) is a rare hematolymphoid neoplasm that accounts for approximately 0.2% of new cancer cases worldwide, being more common in young adults between the ages of 20-34 years. It represents the most recurring oncological disease in this age group. The pathology is divided into two groups: Classic Hodgkin Lymphoma (CHL), which is further subdivided into four histologies, and Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL), accounting for approximately 90% and 10% of the reported cases, respectively. These two disease presentations are distinguished by the presence of characteristic cells, such as Reed-Sternberg cells in CHL and predominantly lymphocytic cells in NLPHL. The pathological diagnosis of HL is preferably performed through excisional biopsy and immunohistochemical evaluation. The accurate diagnosis, staging based on the Ann Arbor classification, and evaluation of risk factors are essential for choosing the correct treatment. Currently, positron emission tomography with computed tomography (PET/CT) is the most important imaging technique for assessing the disease. This complementary examination allows for evaluating the response to therapy through restaging. This approach enables personalized and response-directed treatment for patients. The therapy for HL mainly involves a combined regimen of radiation therapy and chemotherapy, with ABVD and BEACOPPesc being the most used protocols. With an approach guided by treatment response using PET/CT, HL is currently one of the oncological diseases with the highest success rates, aiming for disease cure as the ultimate therapeutic goal. However, despite the excellent results of the combined classical therapy, 10% to 30% of patients experience relapse or are refractory to treatment. Therefore, there is a need to expand the therapeutic arsenal in order to provide a response for these patients. New therapeutic approaches emerge, not only in terms of new drugs but also in the optimization of existing therapies and in combination with these new therapeutic alternatives. Notable approaches include those mainly belonging to targeted therapy, such as antibody-drug conjugates, immune checkpoint inhibitors, inhibitors of oncogenic signaling pathways, and immunomodulators, which have already been implemented in clinical practice.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2023, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Linfoma de Hodgkin Quimioterapia Terapêutica dirigida PET/CT Mestrado Integrado - 2023