Carcinoma do pulmão de pequenas células – Estado da arte e perspectivas futuras

Small cell lung cancer – State of the art and future perspectives

 

Fernando J Barata¹

Ana Filipa Costa¹

 

Resumo

Em Portugal, o cancro do pulmão é a principal causa de morte entre as neoplasias. Em 2006 são previstos mais de 3500 novos casos, dos quais 20% serão diagnosticados como carcinoma do pulmão de pequenas células (CPPC). Destes, 25% a 30% dos doentes serão estadiados como doença localizada ou regional. Para estes, a opção terapêutica passa pela combinação da radioterapia (50 Gy ou 60 Gy) diária e quimioterapia. A radioterapia hiperfraccionada, em consequência da sua toxicidade, está limitada a doentes seleccionados. A combinação etopósido e cisplatina é sinérgica, bem tolerada. É o regimen standard quer na opção concomitante com a radioterapia, quer isoladamente na doença disseminada. Apesar da quimiossensibilidade e radiosensibilidade, o prognóstico global do CPPC é pobre. Há um desenvolvimento precoce de resistência associado a uma elevada predisposição para a recidiva. A terapêutica de segunda linha para o CPPC é um problema real e actual. Topotecano é hoje uma opção efectiva e bem tolerada no tratamento em segunda linha do CPPC. Há um aumento significativo da sobrevivência mediana versus a terapêutica sintomática. A sua eficácia é comparável ao clássico regimen CAV. Mostra boa tolerabilidade mesmo quando administrado em doentes idosos, com PS=2. Continua a ser bem tolerado e eficaz quando combinado com a radioterapia holocraniana cerebral ou quando administrado num esquema semanal. Com novas classes de fármacos, como agentes antiangiogénicos como o bevacizumab, inibidores da tirosina quinase e talidomida, decorrem ensaios avaliando a sua associação com a clássica quimioterapia em doentes com CPPC disseminada.

Palavras-Chave: Carcinoma pulmonar de pequenas células, CPPC, cancro do pulmão, topotecano

 

Abstract

Lung cancer is the leading cause of cancer related death in Portugal. Almost 3500 Portuguese are expected to be diagnosed with lung cancer in 2006; approximately 20% will have small cell lung cancer (SCLC). At presentation, 25% to 30% of patients will have local or regional disease, classified as limited stage disease. The concurrent chemovalidation therapy is the best choice. Once daily thoracic radiation therapy to doses in the range of 50 Gy to 60 Gy would reflect an accepted standard of care in daily practice. Because of the increase toxicity associated with hyper fractionated radiation, this approach is often limited to select patients. Etoposide plus cisplatin are synergistic, well tolerated and result in equal or superior survival compared with other regimens. This is the standard regimen for concomitant therapy in limited stage and for extensive disease SCLC. Despite good chemo sensitivity and radio sensitivity, the prognosis of SCLC is very poor because of the early development of resistance and the associated high tendency to recurrence, making second line treatment of SCLC a problem of real medical relevance. Topotecan now offers an effective and well tolerated monosubstance for second line therapy of recurrent SCLC. There has been a significant increase in median survival for patients with SCLC receiving topotecan plus symptomatic therapy sversus symptomatic therapy. The efficacy of this drug is comparable to the efficacy of the three-drug combination CAV. The tolerability can be improved by means of toxicity-adapted dosing. In elderly and in patients with performance status 2, topotecan is also well tolerated and has good efficacy. Initial studies into weekly administration also demonstrate good efficacy. The combination of topotecan with cranial radiotherapy is well tolerated and effective in the treatment of cerebral metastases of SCLC. New classes of agents, such as antiangiogenic agents including bevacizumab, small molecule tyrosine kinase inhibitors and thalidomide are being evaluated with chemotherapy for patients with extensive stage SCLC.

Key-Words: Small cell lung cancer, lung cancer, topotecan, SCLC

 

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¹ Serviço de Pneumologia. Centro Hospitalar de Coimbra.

 

Recebido para publicação/received for publication: 06.10.31

Aceite para publicação/accepted for publication: 07.03.26