Monoclonal antibodies for diagnosis and therapy of squamous cell carcimona of the head and neck
Abstract
O grupo de carcinomas espinocelulares da cabeça e pescoço em pacientes com alto risco de desenvolver metástases à distância, tem sido bem definidos do ponto de vista prognóstico em nossa instituição. Com intuito de selecionar fatores de risco preditivos no desenvolvimento de metástases à distância, Leemans e col analisaram um grupo de 281 pacientes com carcinoma epidermóide que não desenvolveram doença recorrente acima da clavícula (79). Todos os pacientes foram primariamente operados e submetidos à radioterapia complementar diante de 3 ou mais linfonodos histológicos metastáticos na avaliação da peça operatória, sendo que neste grupo, a incidência de metástases à distância a 5 anos foi de 10,7%. 0 número de metástases em Iinfonodos em n4 de 3 ou mais, foi determinante do desenvolvimento de metástases à distância em 50% dos casos, fato este não detectado quando esta cifra estava abaixo de 3 linfonodopatias. Em contrapartida, a presença de ruptura extra-capsular foi um fator dramático de mudança de prognóstico no que diz respeito à presença de metástases à distância (3 vezes mais que nos casos onde a ruptura extra-capsular estava ausente). Outro aspecto que mereceu a atenção dos autores, foi aquele relacionado com os pacientes recidivados loco-regionalmente ocorrendo nestes pacientes duas vezes mais metástases sistêmicas (80,81). A opção proposta no sentido de introduzir uma terapia adjuvante para os pacientes com alto risco de desenvolver metástases à distância, é o emprego de anticorpos monoclonais marcados.
Recentemente, apresentamos um primeiro estudo experimental em carcinoma epidermóide da cabeça e pescoço tratados por radio-imunoterapia. Foi demonstrado que a IgG E48 de anticorpos monoclonais marcados com 1131 foi capaz de eliminar implantes humanos de carcinoma escamocelular em tumores transplantados para ratos(82). Em 20% dos experimentos desenvolvidos (2 em 10 tumores), foi observada uma regressão em ratos tratados com 400iCi de IgG E48 de anticorpos monoclonais marcados com lodo 131 tratados com 800 µCi, 2 em 7 tumores(29%) mostraram completa remissão sem recidiva durante o seguimento (> 3 meses). Nos mesmos casos, a utilização de quimioterapia com doxorubicina, 5 fluor-uracil, cisplatinum e methotrexate exibiram uma resposta menor, demonstrando um efeito antitumoral mais fugaz, não ocorrendo nenhuma cura com o emprego de antiblásticos. Este dados sugerem que o emprego da radio-imunoterapia no tratamento do câncer da cabeça e pescoço, pode se transformar numa nova alternativa no tratamento das lesões com altas capacidade de recidiva e disseminação.
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