왼쪽 유방 암이냐 오른쪽 유방 암이냐에 따라 > 임상 응용 정보

왼쪽 유방 암이냐 오른쪽 유방 암이냐에 따라

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왼쪽 유방 암이냐 오른쪽 유방 암이냐에 따라 </TD></TR>
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왼쪽 유방암은 오른쪽 유방암에따라 
심장 마비 발생율이 3배나 더 높다는 사실이 밝혀졌다
 
이들이 유방암 치료제 (Trastuzumab)를 투약 받는 자는
28%가 심부전을 일으킨다
 
이는 텍사스 앤더슨 암 연구소 와 펜실베니아 의대 연구팀이 
각각 연구 한 결과이며 
임상 종양 학회지를 통해 동시에 발푣힌 내용이다
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왼쪽 유방암이 문제</TD></TR>
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1977년에서 1994년 사이에 유방암 방사선 치료를 받은 
유방 암 환자를 22년간 추적 조사 분석해 본 결과는 아래 와 같다.
 
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왼쪽 유방 암 환자   (484명)</TD>
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오른쪽 유방암 환자    (477명)</TD></TR>
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심장 마비</TD>
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15%</TD>
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5%</TD></TR>
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관동맥 질환(심근 경색)</TD>
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25%</TD>
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10%</TD></TR>
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심장병 사망자</TD>
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6.4%</TD>
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3.4%</TD></TR></TBODY></TABLE>
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왼쪽 유방암 지닌 여인들중에서 
유방암 치료제(Trastuzumab) 주사 요법자의 28%가 심부전</TD></TR>
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주사 받은 자 총 수</TD>
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218명 중 173명 (약 3 년간 관찰)</TD></TR>
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심부전 이상자 총 수</TD>
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28%</TD></TR>
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좌심박출력 (LVEF) 20% 이상 감소</TD>
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1.7%</TD></TR>
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심장 독성 (Grade 2)</TD>
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15.6%</TD></TR>
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심장 독성 (Grade3)</TD>
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10.9%</TD></TR></TBODY></TABLE>
 
 
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Trastzumab 이라는 항암제</TD></TR>
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Trastzumab 은 유방 암 세포 막에 결합하여
암 세포가 자라나지 않게 하는 약이다
 

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 <IMG src="/_dimg/1%20herceptin.png"></TD></TR>
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[왼쪽 그림] 성장인자(EGF) 가 암세포 수용체(빨간색)에 결합하면 
              암세포가 성장한다. Herceptin(Trastuzumab)은 이 수용체에
              결합하여 성장인자가 결합함을 억제한다.
[오른 쪽 그림] 화살은 유방암 치료제 Traastzumab (Herceptin)이며 
성장 인자가 수용체에 결합하는 것을 막고 있다</TR></TBODY></TABLE></TD></TR>
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항암제 치료 중 심장 병 나타나면</TD></TR>
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Trastuzumab 치료 중 심장 병이 나타나면 즉시 항암 요법을 중단해야 한다.
 
그리고 즉시 ACEI (예 Ramipril 등)으로
심부전 치료 법을 실시하면 대부분이 잘 치료된다고 발표했다.
 
그리고 심부전이 치료된 후 다시 Trastuzumab 요법을 실시하면 된다.
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심장 전문의의 계속적 검진 필요</TD></TR>
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 항암제(Trastuzumab) 요법을 받는 자와 
좌측 유방암 환자는 특히 심장 전문의와 계속적 
검진을 해야 한다고 발표 했다.
 
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근거</TD>
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J Clin Oncol. 2006 Aug 14; 
Long-Term Cardiac Tolerability of Trastuzumab in Metastatic Breast Cancer: The M.D. Anderson Cancer Center Experience.
Guarneri V, Lenihan DJ, Valero V, Durand JB, Broglio K, Hess KR, 
Michaud LB, Gonzalez-Angulo AM, Hortobagyi GN, Esteva FJ. 
Departments of Breast Medical Oncology, Cardiology, Biostatistics and Applied Mathematics, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
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