Erkekte Meme Kanseri Tedavisi
Özet
Erkek meme kanseri (EMK), kadın meme kanserine (KMK) kıyasla biyolojik olarak belirgin farklılıklar gösterse de, mevcut tedavi protokolleri büyük oranda kadın hastalar üzerinde yürütülen klinik çalışmalara dayanmaktadır. Bu nadir hastalıkta temel ve en yaygın tedavi yöntemi mastektomidir; çünkü erkeklerde meme dokusunun küçük olması, tümörün genellikle meme ucu arkasında lokalize olması ve ileri evrede tanı konulması, meme koruyucu cerrahinin uygulanmasını sınırlandırmaktadır. Cerrahi müdahalenin ardından hastalığın evresine ve nüks riskine göre adjuvan radyoterapi göğüs duvarına uygulanabilmektedir. Hastaların çoğunluğu östrojen ve androjen reseptör pozitifliği taşıdığı için sistemik tedavinin merkezinde endokrin yaklaşımlar yer alır ve 5 yıl süreyle tamoksifen kullanımı standart adjuvan tedavi olarak kabul edilir. Ancak erkeklerde tamoksifene bağlı yan etkilerin yüksek olması tedavi uyumunu zorlaştırabilmektedir. Yüksek riskli, aksiller lenf nodu pozitifliği olan ya da ileri evre vakalarda antrasiklin ve taksan bazlı kemoterapiler sağkalımı artırmak amacıyla tedaviye dahil edilmektedir. Son yıllarda metastatik ve ileri evre EMK yönetiminde CDK 4/6 inhibitörleri, fulvestrant ve HER2 pozitif nadir vakalarda trastuzumab gibi hedefe yönelik biyolojik ajanlar ile gen ekspresyon profilleme testleri (Oncotype Dx) tedavi kararlarında giderek daha fazla yer bulmaktadır.
Male breast cancer (MBC) exhibits distinct biological features compared to female breast cancer (FBC), yet its management strategies are largely adapted from clinical trials conducted on female patients. Mastectomy remains the primary and most frequent surgical intervention for MBC due to the limited volume of male breast tissue, central tumor localization beneath the nipple-areola complex, and delayed diagnosis at advanced stages, which constrain the feasibility of breast-conserving surgery. Following surgery, adjuvant radiotherapy is implemented based on disease stage and recurrence risks to optimize locoregional control. Since a vast majority of MBC tumors express estrogen and androgen receptors, endocrine therapy serves as the cornerstone of systemic management, with a 5-year course of tamoxifen established as the standard adjuvant protocol. However, treatment adherence can be challenging due to a high incidence of adverse effects in men. For high-risk individuals exhibiting axillary lymph node involvement or advanced stages, anthracycline- and taxane-based chemotherapy regimens are utilized to enhance overall survival. Recently, targeted biological agents including CDK 4/6 inhibitors, fulvestrant, and trastuzumab for rare HER2-positive cases, alongside multigene assays like Oncotype Dx, are increasingly utilized to guide personalized therapeutic strategies in metastatic and advanced settings.
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