Fronteiras fluidas: a trajetória de padronização de um medicamento para câncer de mama metastático no Brasil e a mobilização de estratégias para a sua expressão social.

Abstract

This essay is a case study about the process of standardization and dissemination strategies of the medicine T-DM1/Kadcyla®, situated in the theoretical fields of Sociology and Anthropology of Pharmaceuticals. Its purpose is to identify how the social value of a medicine is established and its trajectory alongside a complex network that involves patient groups, physicians, scientists pharmaceutical industry and regulatory agencies. T-DM1/Kadcyla® is antibody-drug conjugate directed at the treatment of patients with HER2-positivemetastatic breast cancer, when the disease has reached other locations and there is no possibility for biomedical cure. This drug was approved by the brazilian regulatory agency (ANVISA) in 2014, but its dispensation in the country began in 2010 through regulated clinical trials. The research was conducted through the documentary analysis of the means of dissemination of T-DM1/Kadcyla® in the website of the pharmaceutical lab Roche. Publications from electronic media of activist groups organized around the issue of cancer in Brazil were also used (FEMAMA and Oncoguia Institute), as well as the advertising material from the public petition Por mais tempo , promoted in 2015. Whilst investigating the way in which a medication containing advanced technology is translated into local context, two strategies were identified: information on the molecular patterns of the breast tumors that would respond to specific medicines and the emphasis in some individual experiences deemed successful and taken as exemplary in the struggle against metastatic conditions. Thenceforth, the present study discusses the way in which the dynamics of expectations is triggered in this palliative context and the participation of the pharmaceutical industry in the mobilization of a sociability marked by biological criteria, based on the concept of personalized medicine. It is proposed a reflection on the challenges and deadlocks for the coping agenda towards breast cancer in the brazilian public health system.