Der Gynäkologe

, Volume 45, Issue 6, pp 443–447

Aktuelle Veränderungen der S3-Leitlinie Mammakarzinom

Adjuvante Systemtherapie
Leitthema
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Zusammenfassung

Die medikamentöse Systemtherapie ist wichtiger Bestandteil eines multimodalen Therapiekonzeptes beim primären Mammakarzinom. Sie wird als Chemotherapie, endokrine Therapie, Anti-HER2-Antikörpertherapie oder als Kombination bzw. Sequenz dieser Therapieformen vor (neoadjuvant) oder nach (adjuvant) der Operation durchgeführt. Die Systemtherapie reduziert nachweislich Rezidivrate und Mortalität. Dies gilt für die Polychemotherapie (Gabe von Anthrazyklinen und Taxanen), für die medikamentöse Ausschaltung der Ovarialfunktion, für Tamoxifen, Aromatasehemmer und Trastuzumab. Das absolute Ausmaß dieser Effekte ist abhängig vom individuellen Rezidivrisiko. Ältere Patientinnen sollten eine Systemtherapie erhalten, die der für jüngere Patientinnen vergleichbar ist. Bei Indikationsstellung und Durchführung sind veränderte Organfunktionen und Komorbiditäten zu berücksichtigen. Eine optimale supportive Therapie (z. B. Myelopoesestimulation, Antiemese, Versorgung mit Perücken etc.) ist integraler Bestandteil aller systemischen Therapien. Alle Patientinnen müssen über mögliche Nebenwirkungen und Spätfolgen aufgeklärt werden und Prophylaxemaßnahmen angeboten bekommen. Im Beitrag werden die aktuellen S3-Leitlinienempfehlungen 2012 für die adjuvante, d. h. die postoperative Systemtherapie zusammengefasst.

Schlüsselwörter

Systemtherapie Tumorbiologie Adjuvante Chemotherapie Endokrine Therapie Trastuzumab 

Current amendments to the S3 guidelines on breast cancer

Adjuvant systemic therapy

Abstract

Systemic therapy is a key element of the multimodal therapy concept in early breast cancer. It comprises chemotherapy, endocrine therapy or anti-HER2 antibody therapy and is given as combination with or in sequence before (neoadjuvant) or after (adjuvant) surgery. Adjuvant systemic therapy, i.e. polychemotherapy with anthracyclines and taxanes, endocrine therapy with gonadotropin-releasing hormone (GnRH), tamoxifen or aromatase inhibitors, and trastuzumab, reduces the risk of relapse and mortality in primary breast cancer. The absolute magnitude of this reduction depends on the individual relapse risk. Elderly patients should receive adjuvant systemic therapy comparable to that in younger patients provided that altered organ function and co-morbidities have been taken into account. Optimal supportive care (e.g. growth factors, antiemesis or wigs) is an essential part of systemic therapy. All patients need to be thoroughly counselled about possible side effects and late toxicities and need to be informed about potential prophylactic measures. This article summarizes the current 2012 S3 breast cancer guideline recommendations for adjuvant, i.e. postoperative systemic therapy.

Keywords

Systemic therapy Tumor biology Adjuvant chemotherapy Endocrine therapy Trastuzumab 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Brustzentrum der Universität MünchenUniversitätsfrauenkliniken Grosshadern und Maistrasse - InnenstadtMünchenDeutschland
  2. 2.Medizinischen Klinik mit Schwerpunkt Onkologie und HämatologieUniversitätsmedizin Charité, BerlinBerlinDeutschland
  3. 3.Universitätsfrauenklinik Halle/SaaleHalle/SaaleDeutschland

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