000			11018namaa22004331c 4500
003			OSt
005			20250223033259.0
008			240917b2023 |||a|||f m||| 001 0 eng d
040			_aEG-GICUC _beng _cEG-GICUC _dEG-GICUC _erda
041	0		_aeng _beng _bara
049			_aDeposite
082	0	4	_a616.99449
092			_a616.99449 _221
097			_aM.Sc
099			_aCai01.19.04.M.Sc.2023.Es.E
100	0		_aEsraa Ibraheem Mohamed Metwalli Sallam, _epreparation.
245	1	0	_aEfficiency of second line hormonal treatment in hormone receptor positive human epidermal growth factor receptor type 2 negative recurrent and or metastatic breast cancer / _cBy Esraa Ibraheem Mohamed Metwalli Sallam ; Supervised by Dr. Alfred Elias Namour , Dr. Abd El Hamid Mohamed Fouad , Dr. Alshimaa Zakaria Fathy
246	1	5	_a /ﻛﻔﺎءة اﻟﻌﻼج اﻟﮭﺮﻣﻮﻧﻲ ﻣﻦ اﻟﺨﻂ اﻟﺜﺎﻧﻲ ﻓﻲ ﺳﺮطﺎن اﻟﺜﺪي اﻟﻤﻨﺘﺸﺮ أو اﻟﻤﺮﺗﺠﻊ إﯾﺠﺎﺑﻲ اﻟﻤﺴﺘﻘﺒﻼت اﻟﮭﺮﻣﻮﻧﯿﺔ وﺳﻠﺒﻲ ﻋﺎﻣﻞ اﻟﻨﻤﻮ اﻟﺒﺸﺮي ﻣﻦ اﻟﻨﻮع اﻟﺜﺎﻧﻲ
264		0	_c2023.
300			_a136 pages _billustrations ; _c25 cm. + _eCD.
336			_atext _2rda content
337			_aUnmediated _2rdamedia
338			_avolume _2rdacarrier
502			_aThesis (M.Sc.)-Cairo University, 2023.
504			_aBibliography: pages 105-134.
520			_aBackground: Metastatic breast cancer is incurable & there’s currently no standard of care so treatment goals are to prolong survival, delay disease progression, and enhance quality of life. Therefore choice of treatment should consider tumor characteristics to choose the most suitable drug to decrease disease burden with least side effect until evident unacceptable toxicity or disease progression. Since endocrine treatment (ET) with or without targeted therapy is less toxic than chemotherapy, it’s preferable to start with ET in luminal MBC& If a patient initially responds to an ET and then progresses, another ET may be used ET include; SERMs (Tamoxifen & Toremifene), AIs including; non-steroidal AIs (Anastrazole, Letrezole) & steroidal AIs (Exemestane), as well as SERDs (Fulvestrant). Objective: Evaluating the efficacy & safety of second line hormonal treatment in hormone receptor positive, HER2 negative recurrent & or metastatic breast cancer. -Patients and methods: This retrospective study included 116 female patients with hormone receptor positive, HER2 negative breast cancer, 29 of them had metastasis at initial presentation, 24 had isolated loco-regional recurrence and 63 developed distant recurrence after being treated as early or locally advanced breast cancer, all of cases failed on first line hormonal treatment & received second line hormonal treatment at medical oncology department of National cancer institute – Cairo University & started second line hormonal treatment in the period between January 2015 and December 2019 with follow up till June 2022. -Results: Among 116 females we assessed efficacy of second line hormonal treatment with Fulvestrant (n=68), AI (n=44) which was sub-classified into (Exemestane (n=31) & Anastrazole (n=13)) & Tamoxifen (n=4). Results demonstrated Response rate (26.5% vs. 11.3%), clinical benefit rate (61.8% vs. 86.18%), median PFS (17.072 vs. 16.97 months) while median OS (147.2 vs. 105.09 months) for fulvestrant & AI respectively , while regarding type of AI, response rate was (9.7% vs. 15.4% ), clinical benefit rate (64.5% vs. 76.9%) , median PFS (18.06 vs. 14.05 months) while median OS (102.17 vs. 153.84 months) in exemestane & anastrozole respectively with tolerable side effects with all lines. Most common side effects were bony aches (28.3% with fulvestrant vs. 31.6 with AI) & fatigue (21.7% with fulvestrant vs. 15.8% with AI) (p; 0.001) -Conclusion: There was no statistically significant difference found between different endocrinal treatments (Fulvestrant, AIs, tamoxifen) which were used as second line as regard response rate, clinical benefit rate, PFS & OS with tolerable side effects.
520			_aﯾﻌد ﺳرطﺎن اﻟﺛدي أﻛﺛر اﻻﻣراض اﻟﺳرطﺎﻧﯾﺔ اﻧﺗﺷﺎرا ﻓﻲ اﻟﻧﺳﺎء ﻓﻲ اﻟوﻻﯾﺎت اﻟﻣﺗﺣدة وﺛﺎﻧﻲ أﻛﺛر اﻻورام ﺳﺑﺑﺎ ﻟﻠوﻓﺎة ﺑﻌد ﺳرطﺎن اﻟرﺋﺔ ﺳرطﺎن اﻟﺛدي اﯾﺟﺎﺑﻲ اﻟﻣﺳﺗﻘﺑﻼت اﻟﮭرﻣوﻧﯾﺔ وﺳﻠﺑﻲ ﻣﻌﺎﻣل ﻧﻣو اﻟﺑﺷرة ٢ھو أﻛﺛر ﻧوع ﻣن اﻟﺗﺻﻧﯾﻔﺎت اﻟﻔرﻋﯾﺔ اﻟﺟزﯾﺋﯾﺔ. ﺳرطﺎن اﻟﺛدي اﻟﻣﻧﺗﺷر ﻏﯾر ﻗﺎﺑل ﻟﻠﺷﻔﺎء اﻟﺗﺎم وﻟﻛن ھﻧﺎك ﺗﺣﺳن ﻓﻲ ﻣﻌدل اﻟﺑﻘﺎء ﻋﻠﻰ ﻗﯾد اﻟﺣﯾﺎة ﻣﻊ اﺳﺗﺧدام اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ وﻟذﻟك ﯾﺗم اﺧﺗﯾﺎر اﻟﻌﻘﺎر اﻟﻣﻧﺎﺳب ﻟﺗﻘﻠﯾل ﺣدة اﻟﻣرض ﺑﺄﻗل اﺛﺎر ﺟﺎﻧﺑﯾﺔ ﻣﻣﻛﻧﺔ وذﻟك ﺣﺗﻰ ﺣدوث اﺛﺎر ﺟﺎﻧﺑﯾﺔ ﻏﯾر ﻣﺣﺗﻣﻠﺔ او ﺣدوث ﺗطور ﻓﻲ اﻟﻣرض وﻻن اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ واﻟﻣوﺟﮫ اﻗل ﺳﻣﯾﺔ ﻣن اﻟﻌﻼج اﻟﻛﯾﻣﯾﺎﺋﻲ ﻟذا ﯾﻔﺿل ان ﯾﺑدأ ﺑﮫ اﻟﺳﯾدات اﻟﻼﺗﻲ ﺗطور ﻟدﯾﮭن اﻟﻣرض ﺑﻌد ٢١ﺷﮭر او أﻛﺛر ﻣن اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ اﻟﻣﺳﺎﻋد او ﻣن ﺣدث ﻟﮭم اﻧﺗﺷﺎر ﺣدﯾﺛﺎ ﯾﺗم اﺳﺗﺧدام ﺧط اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ اﻻول ﺑﺎﻟرﻏم م وﺟود ﻗﻠﺔ ﻣن اﻟﻣرﺿﻲ ﯾﻌﺎﻧﯾن ﻣن ﺛﺎﻧوﯾﺎت ﺷدﯾدة ف اﻻﺣﺷﺎء ﻓﻲ ﺻورة اﻋراض ﺗﻧﻔﺳﯾﺔ او ارﺗﻔﺎع ﻓﻲ اﻧزﯾﻣﺎت اﻟﻛﺑد وﺣﯾﻧﮭﺎ ﯾﺑدأ اﻟﻌﻼج اﻟﻛﯾﻣﺎوي ﻟﺗزﯾد ﻓرص اﻻﺳﺗﺟﺎﺑﺔ اﻟﺳرﯾﻌﺔ ﻟﻠﻣرض إذا ﺣدث ﺗطور ﻟﻠﻣرض ﻣﻊ ﺧط اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ اﻻول ﺣﯾﻧﮭﺎ ﯾﺗم اﺳﺗﺧدام ﺧط اﻟﻌﻼج اﻟﺛﺎﻧﻲ ﻓﻲ ﺣﺎﻟﺔ ﻓﺷل اﻻﺳﺗﺟﺎﺑﺔ ﻟﻠﻌﻼج او اﻟﺗوﻗف ﻋﻧﮭﺎ ﺣﯾﻧﮭﺎ ﯾﺟب ﻣﻌرﻓﺔ: ﻧﺳﺑﺔ ﻣﺳﺗﻘﺑﻼت اﻻﺳﺗروﺟﯾن ﻓﻲ اﻻﻧﺳﺟﺔ ﻣدة اﻻﺳﺗﺟﺎﺑﺔ ﻟﺧط اﻟﻌﻼج اﻻول ﺗﺣﻣل اﻟﻣرﯾض ﻟﺧط اﻟﻌﻼج اﻻول ووﺟود او ﻋدم وﺟودة ﺛﺎﻧوﯾﺎت ﻋﻧﯾﻔﺔ ﻓﻲ اﻻﺣﺷﺎء وذﻟك ﻟﯾﺗم ﺗﺣدﯾد إذا ﻛﺎن اﻟﻣرﯾض ﻓﻲ ﺣﺎﺟﺔ ﻟﻠﻌﻼج اﻟﻛﯾﻣﯾﺎﺋﻲ ﻟﻠﺣﺻول ﻋﻠﻰ اﺳﺗﺟﺎﺑﺔ أﺳرع ام اﻟﺗﻐﯾر ﻟﺧط اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ اﻟﺛﺎﻧﻲ اﻟﻐرض ﻣن ھذه اﻟرﺳﺎﻟﺔ ھو ﺗﻘﯾﯾم ﻛﻔﺎءة اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ ﻛﺧط ﻋﻼج ﺛﺎﻧﻲ ﻓﻲ ﺳرطﺎن اﻟﺛدي اﯾﺟﺎﺑﻲ اﻟﻣﺳﺗﻘﺑﻼت اﻟﮭرﻣوﻧﯾﺔ وﺳﻠﺑﻲ ﻣﻌﺎﻣل ﻧﻣو اﻟﺑﺷرة اﻟﻣﻧﺗﺷر او اﻟﻣرﺗﺟﻊ اﻟذﯾن ﺑدأوا اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ ﻓﻲ اﻟﻔﺗرة ﻣن ﯾﻧﺎﯾر ﺣﺗﻲ دﯾﺳﻣﺑر ٩١٠٢ ﻣﻊ ﻣﺗﺎﺑﻌﺔ اﻟﺣﺎﻻت ﺣﺗﻲ ﯾوﻧﯾو ٢٢٠٢ ﻛﺗﺟرﺑﺔ ﻗﺳم طب اﻻورام – اﻟﻣﻌﮭد اﻟﻘوﻣﻲ ﻟﻸورام_ﺟﺎﻣﻌﺔ اﻟﻘﺎھرة ھذه اﻟدراﺳﺔ اﺣﺗوت ﻋﻠﻲ ٦١١ اﻣرأة ﺗﻌﺎﻧﻲ ﻣن ﺳرطﺎن اﻟﺛدي اﯾﺟﺎﺑﻲ اﻟﻣﺳﺗﻘﺑﻼت اﻟﮭرﻣوﻧﯾﺔ وﺳﻠﺑﻲ ﻣﻌﺎﻣل ﻧﻣو و ٤٢ ﺣﺎﻟﺔ ﻛﺎﻧت ﺣﺎﻟﺔ ﺣﺎﻟﺔ ﻛﺎﻧت ﺗﻌﺎﻧﻲ ﻣن ﺳرطﺎن ﻣﻧﺗﺷر ﻣﻧذ اﻟﺑداﯾﺔ اﻟﺑﺷرة اﻟﻣﻧﺗﺷر او اﻟﻣرﺗﺟﻊ: ٩٢ ﻣرﺗﺟﻌﺔ و ٣٦ ﻋﺎﻧت ﻣن اﻻﻧﺗﺷﺎر ﺑﻌد ﺗﺷﺧﯾﺻﮭﺎ وﻋﻼﺟﮭﺎ ﻛﺳرطﺎن ﺛدي ﻣﺑﻛر ﺟﻣﯾﻌﮭم ﻓﻘدوا اﻻﺳﺗﺟﺎﺑﺔ ﻟﻠﻌﻼج اﻟﮭرﻣوﻧﻲ ﻛﺧط أول وﺗﻠﻘوا ﻋﻼج ھرﻣوﻧﻲ آﺧر ﻛﺧط ﺛﺎﻧﻲ. واوﺿﺣت ﻧﺗﺎﺋﺞ اﺳﺗﺧدام اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ ﻛﺧط ﻋﻼﺟﻲ ﺛﺎﻧﻲ ﺑﻌﻘﺎر ﻓوﻟﻔﺳﺗراﻧت (fulvestrant) ﻗد ﺣﻘق ﻣﻌدل اﺳﺗﺟﺎﺑﺔ ٥,٦٢% ، ﻣﻌدل اﺳﺗﻔﺎدة اﻛﻠﯾﻧﯾﻛﯾﺔ ٨,٣٣% ﻛﻣﺎ ﻧﺗﺞ ﻋﻧﮫ ﻣﺗوﺳط ﺑﻘﺎء ﺧﺎﻟﯾﺎ ﻣن اﻟﻣرض ﯾﺻل اﻟﻲ, ٣ ﺳﻧوات ٩,٩١% و ﻣﻌدل ﺑﻘﺎء ﻋﻠﻲ ﻗﯾد اﻟﺣﯾﺎة ﯾﺻل اﻟﻲ ﺧﻼل ٧١,٢٧٠ ﺷﮭرا ﺑﻣﻌدل ﺑﻘﺎء ﺧﺎﻟﻲ ﻣن اﻟﻣرض ﺑﯾﻧﻣﺎ اﻟﻌﻼج ﺑﻣﺛﺑطﺎت اﻧزﯾم اﻻروﻣﺎﺗﯾز ٥ ﺳﻧوات٤,٠٩% ٢,٧٤١ ﺷﮭرا ﺑﻣﻌدل ﺑﻘﺎء ﻋﺎم ﻋﻠﻲ ﻗﯾد اﻟﺣﯾﺎة ﺧﻼل inhibitors) (AI ﺣﻘق ﻣﻌدل اﺳﺗﺟﺎﺑﺔ ٣,١١% ، ﻣﻌدل اﺳﺗﻔﺎدة اﻛﻠﯾﻧﯾﻛﯾﺔ ٨١,٦٨ % ﻛﻣﺎ ﻧﺗﺞ ﻋﻧﮫ ﻣﺗوﺳط ﺑﻘﺎء ﺳﻧوات ٤,٩١% و ﻣﻌدل ٧٩,٦١ ﺷﮭرا ﺑﻣﻌدل ﺑﻘﺎء ﺧﺎﻟﻲ ﻣن اﻟﻣرض ﺧﻼل ٣ ﺧﺎﻟﯾﺎ ﻣن اﻟﻣرض ﯾﺻل اﻟﻲ ﺳﻧوات١٨% . ﺷﮭرا ﺑﻣﻌدل ﺑﻘﺎء ﻋﺎم ﻋﻠﻲ ﻗﯾد اﻟﺣﯾﺎة ﺧﻼل ٥ ﺑﻘﺎء ﻋﻠﻲ ﻗﯾد اﻟﺣﯾﺎة ﯾﺻل اﻟﻲ ٩٠,٥٠١ ﻧﺗﺎﺋﺞ اﻟرﺳﺎﻟﺔ ﻟم ﺗوﺿﺢ ﻓرﻗﺎ واﺿﺣﺎ ﺑﯾن ﺧطوط اﻟﻌﻼج اﻟﮭرﻣوﻧﻲ اﻟﻣﺳﺗﺧدﻣﺔ وﻛذﻟك ﺗﺑﯾن وﺟود اﺛﺎر ﺟﺎﻧﺑﯾﺔ اﻛﺛرھﺎ اﻵم اﻟﻌظﺎم واﻹرھﺎق وﻟﻛن ﺟﻣﯾﻊ اﻻﺛﺎر اﻟﺟﺎﻧﺑﯾﺔ ﻛﺎﻧت ﻣﺣﺗﻣﻠﺔ.
530			_aIssues also as CD.
546			_aText in English and abstract in Arabic & English.
650		7	_aBreast cancer _2qrmak
653		0	_aSecond line _ametastatic _arecurrent _aAromatase inhibitors _aEndocrine therapy _aFulvestrant _aluminal
700	0		_aAlfred Elias Namour _ethesis advisor.
700	0		_aAbd El Hamid Mohamed Fouad _ethesis advisor.
700	0		_aAlshimaa Zakaria Fathy _ethesis advisor.
900			_b01-01-2023 _cAlfred Elias Namour _cAbd El Hamid Mohamed Fouad _cAlshimaa Zakaria Fathy _UCairo University _FNational cancer institute _DDepartment of Medical Oncology
905			_aShimaa _eHuda
942			_2ddc _cTH _e21 _n0
999			_c167912