Conclusion
43
V. Conclusion
Le cancer du poumon chez la femme est un complexe
hétérogène, constituant une affection à part
entière. C'est une pathologie peu comprise et peu connue par la
population qui ne cesse de croitre durant ces dernières
années.
Dans notre étude, le cancer du poumon non à
petites cellules a été diagnostiqué chez un nombre non
négligeable de femmes. Il représentait 24,4% des CPNPC totaux et
89,5% des cancers du poumon chez la femme.
Le tabagisme ne constituait pas un facteur de risque chez nos
patientes, en effet celles-ci étaient toutes non fumeuses. D'autres
facteurs d'ordre hormonal, génétique et moléculaires
seraient responsables du CPNPC chez les patientes de notre étude.
L'adénocarcinome était le type histologique
majoritaire (87%) et près de 91 % des CPNPC chez les femmes de notre
série étaient diagnostiqués à un stade
avancé (stade IV) non éligible à la chirurgie justifiant
la nécessité d'instaurer un programme efficace de
prévention contre ce cancer incluant les femmes et de faciliter à
ces dernières l'accès aux moyens de dépistage
précoce.
Seul un tiers des patientes de notre série avaient
réalisé des tests moléculaires. Chez celles-ci une
fréquence élevée de mutations de l'EGFR (48,1%) a
été enregistrée. Les patientes EGFR muté
étaient toutes non fumeuses et avaient toutes un adénocarcinome
non à petites cellules révélant ainsi que le non tabagisme
et le type histologique adénocarcinome sont de bons prédicteurs
des mutations de l'EGFR chez ces patientes.
La thérapie ciblée par les Inhibiteurs de la
Tyrosine Kinase de l'EGFR avait bien démontré chez les patientes
EGFR muté étudiées, sa grande efficacité sur la
survie sans progression médiane et avait également
confirmé son important bénéfice pour la survie globale
médiane de ces patientes indiquant un gain de survie de 11 mois par
rapport à la chimiothérapie par sels de platine.
Ainsi les résultats de notre étude nous incitent
fortement à réaliser les tests de mutations de l'EGFR chez la
totalité des femmes diagnostiquées pour un adénocarcinome
pulmonaire non à petites cellules pour détecter ces mutations et
faire bénéficier ces patientes d'un protocole
thérapeutique adéquat par les ITK de l'EGFR afin
d'améliorer leur survie.
44
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