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Mammakarzinom

Systemische Therapie und Risikoabschätzung

Breast cancer

Systemic therapy and risk prediction

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Der Gynäkologe Aims and scope

Zusammenfassung

Beim Mammakarzinom handelt es sich um den häufigsten gynäkologischen Tumor, dessen Behandlung sich multimodal und interdisziplinär zusammensetzt. Dabei wird in Deutschland unter anderem das neoadjuvante Chemotherapiekonzept angewandt. Eine weit verbreitete Zunahme erfährt die Wirkstoffgruppe der Taxane, die auch in adjuvanten und neoadjuvanten Situationen eingesetzt wird. Der Einsatz zielgerichteter Therapie erfolgt nach den zwei prädiktiven Markern (Hormonrezeptor und Her2neu-Status). Bezüglich der endokrinen Therapie hormonrezeptorpositiver Karzinome erfolgt in der Prämenopause die fünfjährige Gabe von Tamoxifen, in der Postmenopause der Einsatz von Aromataseinhibitoren. Zur Abschätzung der Prädiktion und des Risikos eines Rezidivs etablieren sich immer mehr Tests, die das Genexpressionsprofil des Tumors berücksichtigen, für die jedoch noch keine prospektiven Daten vorliegen. Die Individualisierung der Brustkrebstherapie nimmt vor diesem Hintergrund neue Gestalt an und lässt auf eine individualisierte Therapie mit Erfolgsaussicht und möglichst niedrigen Nebenwirkungsraten hoffen.

Abstract

Breast cancer is the most common gynecological cancer, accounting for almost 70,000 newly diagnosed cases each year. Patients are treated using a multimodal and interdisciplinary effort. Especially the neoadjuvant treatment concept is widely used in Germany. Taxanes are increasingly being routinely used in neoadjuvant and adjuvant therapy schedules. Targeted therapy is based on the two accepted predictive markers (hormone receptor status and the expression of Her2-neu receptors). In premenopausal women, 5 years of tamoxifen remains the standard; aromatase inhibitors should be included in postmenopausal patients. Newly developed tests to predict the risk of recurrence or the benefit from conventional chemotherapies are based on gene expression profiles. The validation of these tests is currently based on retrospective data. However, future developments will provide new possibilities for individualized therapy in breast cancer patients.

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Interessenkonflikt

Dr. med. Dirk O. Bauerschlag gibt an, Beraterhonorar von GSK (GlaxoSmithKline) erhalten zu haben. PD Dr. Marcus Schmidt weist auf folgende Beziehungen hin: Er war als Referent für Sanofi Aventis, Roche, Pfizer, Genomic Health und Sividon tätig und hat von diesen Firmen auch Beraterhonorar erhalten.

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Authors and Affiliations

  1. Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Aachen, RWTH, Pauwelsstr. 30, 52074, Aachen, Deutschland

    D.O. Bauerschlag

  2. Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland

    M. Schmidt

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  1. D.O. Bauerschlag
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  2. M. Schmidt
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Correspondence to D.O. Bauerschlag or M. Schmidt.

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Bauerschlag, D., Schmidt, M. Mammakarzinom. Gynäkologe 45, 623–632 (2012). https://doi.org/10.1007/s00129-012-3007-8

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  • DOI: https://doi.org/10.1007/s00129-012-3007-8

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