dr guilherme costa médico onco-pneumologista 2011
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Dr Guilherme CostaMédico Onco-pneumologista
2011
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1.200.000 mortes – anualmente Principal mortalidade por câncer –
EUA Sobrevida de 5 anos – 20 anos
15% pulmão - 96% próstata
86% mama 61% cólon
Drugs Aging 2008; 25 (3): 209-218Lung Cancer – Chest 2007
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BMJ;311:899-909 1995J Clin Oncol 26:4617-4625. 2008
Doença avançadaQuimioterapia
Qualidade de vida
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Cirurgia Controle local
Radioterapia Controle local
Quimioterapia Controle sistêmico
Weinmann et al. lung cancer 2003Hurria et al. Ca cancer J Clin 2003
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Schiller N Eng J Med, 2002
-Compostos platínicos
-Células em divisão celular
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Média de idade = 68 anos 65-70% dos pacientes > 60 anos 30-40% dos pacientes > 70 anos Em 2030 – População:
> 65 anos – duplique> 80 anos - quadruplique
Weinmann et al. lung cancer 2003Hurria et al. Ca cancer J Clin 2003
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IdadeReserva funcionalAlterações orgânicas -
comorbidadesFarmacocinética das drogasAjuste no tratamento
Monfardini et al. Cancer 1995
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Idade Comorbidades Estadiamento Comportamento
biológico do tumor Melhor terapêutica
oncológica
Zotano AG Lung Cancer. 2005;49(S2):P491.Guralnik JM. Ann Epidemiol. 1996 Sep;6(5):376-80.Finkelstein DM, J Clin Oncol. 1986 May;4(5):702-9.
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J Clin Oncol 25:1898-1907. 2007
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Estudos fase IICarboplatina x CisplatinaToxicidade aceitávelFase III – análise subgrupo Bem tolerada e segura
Hotta k. Lung Cancer 2004
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Sobrevida geral Sobrevida câncer
J Clin Oncol 25:1553-1561. © 2007
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J Clin Oncol 28:2191-2197. 2010
Estudo populacional21.285 pacientes > 66 anos1997 a 2002
Tratamento 1ª linha
Tratamento 2ª linha
2º desafio - tratamento
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J Clin Oncol 28:2191-2197. 2010
Estudo populacional21.285 pacientes
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Lung Cancer (2006) 53, 171—176
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Dose medicaçào
17
33,6
7,39
28,5
10
5
10
15
20
25
30
35
40
Redução Atraso Interrupção
%
> 70 anos < 70 anos
**
* p < 0,05
Lung Cancer (2006) 53, 171—176
P= ns
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J Clin Oncol 26:54-59. 2008
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J Clin Oncol 26:54-59. 2008
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J Clin Oncol 26:2350-2357. © 2008
Sobrevida
Tratamento 1ª linhaInferior no idoso
Tempo livre de doença
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J Clin Oncol 26:60-65. 2008
Sobrevida Tempo livre doença
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76 anos – masculino
Pré-tratamento 4o ciclo
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Pré-tratamento 1o ciclo
77 anos – cardiopata – DPOC
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Desafios: Diagnóstico mais precoce Tratamento adequado
Pacientes CPNPC – individualmente Idade – parâmetros
Terapia oncológica no idoso Monoterapia Poliquimioterapia – Platínicos Terapia alvo + Platínicos Cirurgia + Adjuvância
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