HARAPAN HIDUP PASIEN KANKER PAYUDARA STADIUM AWAL HER-2 POSITIF YANG MENDAPAT TERAPI TRASTUZUMAB ADJUVAN DI RUMAH SAKIT UMUM PUSAT DR. SARDJITO YOGYAKARTA

Maiherizansyah, dr. Johan Kurnianda SpPD-KHOM; Kartika Widayati SpPD-KHOM

2016 | Tesis-Spesialis | S2 Ilmu Penyakit Dalam

Latar belakang. Trastuzumab adalah terapi standar kanker payudara stadium awal HER-2 positif. Trastuzumab digunakan sejak tahun 2007 di Rumah Sakit Umum Pusat (RSUP) Dr. Sardjito. Namun, efikasi dan keamanannya belum pernah dinilai. Penelitian ini mengevaluasi efikasi dan keamanan terapi trastuzumab. Tujuan Penelitian. Tujuan utama penelitian ini adalah untuk menilai overall survival (OS) dan disease free survival (DFS) kanker payudara stadium awal HER-2 positif yang diterapi trastuzumab di RSUP Dr Sardjito. Tujuan sekunder adalah untuk menilai kardiotoksisitas terapi trastuzumab. Metode. Data kanker payudara stadium awal HER-2 positif yang diterapi trastuzumab adjuvan antara Januari 2007 dan Desember 2014 diamati secara retrospektif. Overall survival dan DFS dianalisis dengan menggunakan metode Kaplan-Meier. Uji log rank dilakukan untuk menganalisis perbedaan antara kurva survival. Hasil Penelitian. Sembilan puluh lima subjek diikuti dengan median waktu 26 bulan. Angka OS dan DFS 1 tahun yaitu 96,8% dan 93,6% pada pasien yang mendapatkan terapi trastuzumab. Subjek yang memulai kemoterapi lebih awal (dalam 21 hari sejak operasi) meningkatkan waktu OS dan DFS dibandingkan subjek yang kemoterapinya terlambat (OS 1 tahun yaitu 100% banding 96% dan DFS 1 tahun yaitu 100% banding 92%). Subjek yang diterapi trastuzumab dengan durasi lebih lama (dalam 1 tahun atau lebih) memiliki OS dan DFS yang lebih baik dibandingkan subjek yang durasinya lebih singkat (OS 1 tahun yaitu 100% banding 96.2% dan DFS 1 tahun yaitu 100% banding 92,3%). Tidak ada perbedaan bermakna OS dan DFS berdasarkan status reseptor hormon dan rute pemberian. Insidensi kardiotoksisitas 11,6% (11/95) pada pasien yang mendapat terapi trastuzumab. Hal ini sesuai dengan penelitian-penelitian lainnya. Kesimpulan. Harapan hidup kanker payudara stadium awal HER-2 positif yang mendapat terapi trastuzumab adjuvan di RSUP Dr Sardjito didapatkan hasil OS 1 tahun 96,8% dan DFS 1 tahun 93,6%. Pasien yang mendapatkan terapi trastuzumab adjuvan ditemukan risiko kejadian kardiotoksisitas sebesar 11,6%.

Background. Trastuzumab is the standard treatment of HER2-positive early breast cancer. It has been given since 2007 in Dr Sardjito Hospital. However, its efficacy and safety have not been assessed. This study evaluates the efficacy and safety of trastuzumab therapy. Objectives. The primary endpoint of this study was to assess overall survival (OS) and disease free survival (DFS) of HER2-positive early breast cancer in Dr Sardjito Hospital. The secondary endpoint was to assess the cardiotoxicity of trastuzumab therapy. Methods. Data of HER2-positive early breast cancer receiving adjuvant trastuzumab therapy between January 2007 and Desember 2014 were retrospectively reviewed. Overall survival and DFS were analyzed using Kaplan-Meier method. The log rank test was performed to analyze the difference between survival curves. Results. Ninety-five subjects were followed with a median duration of 26 months. The estimated OS and DFS rates at 1 year were 96,8% and 93,6% respectively among patients receiving trastuzumab. Subjects who started chemotherapy earlier (within less than 21 days from surgery) had better OS and DFS than the subject who received late chemotherapy (1-year OS was 100% vs 96% and 1-year DFS was 100% vs 92 %). Subjects treated with trastuzumab with longer duration (within more than 1 year) had better OS and DFS than the subjects whose duration was shorter (1-year OS was 100% vs 96.2% and 1-year DFS was 100% vs 92,3%). No significant differences in OS and DFS were found based on hormonal receptor status and route of administration. Cardiac toxicity incidence was 11,6% (11/95) in patients receiving trastuzumab, which is similar with other studies. Conclusion. The survival rate of subjects with early HER-2 positive breast cancer treated with adjuvant trastuzumab in Dr Sardjito Hospital are 96,8% for 1-year OS and 93,6% for 1-year DFS. Cardiotoxicity incidence is 11,6% in Patients receiving adjuvant trastuzumab therapy.

Kata Kunci : Kanker payudara, HER-2 positif, trastuzumab, OS, DFS