Loading...
Publication
Fisiopatologia e farmacoterapia do melanoma
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 1.19 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
O melanoma é uma neoplasia maligna que resulta da proliferação anormal dos melanócitos e está associado a diversas alterações moleculares, principalmente nas vias de sinalização MAPK e PI3K/AKT/mTOR, presentes na metastização tumoral. Clinicamente, o melanoma pode ser classificado em quatro subtipos principais, melanoma de extensão superficial, lentigo maligno, melanoma acrolentiginoso e melanoma nodular. Nas últimas décadas, verificou-se um aumento significativo na sua incidência, com uma triplicação dos casos entre 1975 e 2020. De entre os vários tipos de cancro da pele, o melanoma é o que possui menor número de casos, mas com maior número de mortes, sendo o mesmo responsável por 90% das mortes associadas ao cancro da pele.
O tratamento do melanoma varia de acordo com o estádio e a localização do tumor, sendo a cirurgia a abordagem terapêutica mais comum. Nos últimos anos, o tratamento do melanoma evoluiu consideravelmente devido a uma melhoria ao nível da compreensão biológica acerca da patologia. No passado, o tratamento padrão para estádios avançados baseava-se essencialmente na quimioterapia, com o uso de dacarbazina, interleucina-2 em altas doses e interferões. Atualmente, novas terapias têm transformado o prognóstico dos doentes, nomeadamente a imunoterapia e a terapia-alvo.
A imunoterapia, que inclui anticorpos monoclonais responsáveis pelo bloqueio de pontos de controlo imunológicos (checkpoints), como os anti-CTLA-4 (ipilimumab) e anti-PD-1/PDL-1 (pembrolizumab e nivolumab), tem demonstrado grande eficácia. Por outro lado, a terapia-alvo, através de inibidores de tirosina quinase BRAF e MEK (dabrafenib/trametinib, vemurafenib/cobimetinib e encorafenib/binimetinib), tem-se revelado eficaz, particularmente em doentes com mutações no gene BRAF, que ocorrem em 40 a 60% dos casos de melanoma, sendo a mutação BRAFV600E a mais comum, acometendo 90% destas.
O farmacêutico, enquanto profissional de saúde e especialista em medicamentos, desempenha um papel crucial na otimização da farmacoterapia delineada, assim como na gestão e prevenção da doença, contribuindo para a melhoria da qualidade de vida dos doentes.
Melanoma is a malignant neoplasm that results from the abnormal proliferation of melanocytes and is associated with various molecular alterations, primarily in the MAPK and PI3K/AKT/mTOR signalling pathways, which are critical for tumour metastasis. Clinically, melanoma can be classified into four main subtypes, namely superficial spreading melanoma, lentigo maligna, acral lentiginous melanoma, and nodular melanoma. Over the past few decades, a significant increase in its incidence has been observed, with a threefold rise in cases between 1975 and 2020. Among the different types of skin cancer, melanoma has the lowest number of cases but the highest mortality rate, accounting for 90% of deaths related to skin cancer. The treatment of melanoma varies according to the stage and location of the tumour, with surgery being the most common therapeutic approach. In recent years, melanoma treatment has evolved considerably due to an improved understanding of the disease's biological mechanisms. In the past, standard treatment for advanced stages was primarily based on chemotherapy, including dacarbazine, high-dose interleukin-2, and interferons. Currently, new therapies have transformed patient prognosis, particularly immunotherapy and targeted therapy. Immunotherapy, which involves monoclonal antibodies responsible for blocking immune checkpoints such as anti-CTLA-4 (ipilimumab) and anti-PD-1/PDL-1 (pembrolizumab and nivolumab), has shown great efficacy. On the other hand, targeted therapy, through BRAF and MEK tyrosine kinase inhibitors (dabrafenib/trametinib, vemurafenib/cobimetinib and encorafenib/binimetinib), has proven effective, particularly in patients with BRAF mutations, which occur in 40-60% of melanoma cases, with the BRAFV600E mutation being the most common, accounting for 90% of these mutations. As a healthcare professional and medication specialist, the pharmacist plays a crucial role in optimizing the outlined pharmacotherapy, as well as in disease management and prevention, contributing to improved patient quality of life.
Melanoma is a malignant neoplasm that results from the abnormal proliferation of melanocytes and is associated with various molecular alterations, primarily in the MAPK and PI3K/AKT/mTOR signalling pathways, which are critical for tumour metastasis. Clinically, melanoma can be classified into four main subtypes, namely superficial spreading melanoma, lentigo maligna, acral lentiginous melanoma, and nodular melanoma. Over the past few decades, a significant increase in its incidence has been observed, with a threefold rise in cases between 1975 and 2020. Among the different types of skin cancer, melanoma has the lowest number of cases but the highest mortality rate, accounting for 90% of deaths related to skin cancer. The treatment of melanoma varies according to the stage and location of the tumour, with surgery being the most common therapeutic approach. In recent years, melanoma treatment has evolved considerably due to an improved understanding of the disease's biological mechanisms. In the past, standard treatment for advanced stages was primarily based on chemotherapy, including dacarbazine, high-dose interleukin-2, and interferons. Currently, new therapies have transformed patient prognosis, particularly immunotherapy and targeted therapy. Immunotherapy, which involves monoclonal antibodies responsible for blocking immune checkpoints such as anti-CTLA-4 (ipilimumab) and anti-PD-1/PDL-1 (pembrolizumab and nivolumab), has shown great efficacy. On the other hand, targeted therapy, through BRAF and MEK tyrosine kinase inhibitors (dabrafenib/trametinib, vemurafenib/cobimetinib and encorafenib/binimetinib), has proven effective, particularly in patients with BRAF mutations, which occur in 40-60% of melanoma cases, with the BRAFV600E mutation being the most common, accounting for 90% of these mutations. As a healthcare professional and medication specialist, the pharmacist plays a crucial role in optimizing the outlined pharmacotherapy, as well as in disease management and prevention, contributing to improved patient quality of life.
Description
Keywords
Melanoma Fisiopatologia Farmacoterapia Medidas não farmacológicas Farmacêutico