Der Gynäkologe

, Volume 45, Issue 8, pp 623–632

Mammakarzinom

Systemische Therapie und Risikoabschätzung
CME Zertifizierte Fortbildung
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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.

Schlüsselwörter

Brustkrebs Neoadjuvante Therapie Endokrine Therapie Adjuvante Therapie Risikoabschätzung 

Breast cancer

Systemic therapy and risk prediction

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.

Keywords

Breast cancer Neoadjuvant therapy Endocrine treatment Adjuvants, pharmaceutics  Risk prediction 

Literatur

  1. 1.
    Baselga J, Bradbury I, Eidtmann H et al (2012) Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet 379:633–640PubMedCrossRefGoogle Scholar
  2. 2.
    Berry DA, Cronin KA, Plevritis SK et al (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353:1784–1792PubMedCrossRefGoogle Scholar
  3. 3.
    Davies C, Godwin J, Gray R et al (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378:771–784PubMedGoogle Scholar
  4. 4.
    Denkert C, Kronenwett R, Schlake W et al (2012) Decentral gene expression analysis for ER +/Her2- breast cancer: results of a proficiency testing program for the EndoPredict assay. Virchows Arch 460:251–259PubMedCrossRefGoogle Scholar
  5. 5.
    Dowsett M, Cuzick J, Ingle J et al (2010) Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 28:509–518PubMedCrossRefGoogle Scholar
  6. 6.
    Filipits M, Rudas M, Jakesz R et al (2011) A new molecular predictor of distant recurrence in ER-positive, HER2-negative breast cancer adds independent information to conventional clinical risk factors. Clin Cancer Res 17:6012–6020PubMedCrossRefGoogle Scholar
  7. 7.
    Fisher B, Bryant J, Wolmark N et al (1998) Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16:2672–2685PubMedGoogle Scholar
  8. 8.
    Goldhirsch A, Wood WC, Coates AS et al (2011) Strategies for subtypes – dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22:1736–1747PubMedCrossRefGoogle Scholar
  9. 9.
    Goss PE, Ingle JN, Martino S et al (2005) Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst 97:1262–1271PubMedCrossRefGoogle Scholar
  10. 10.
    Hadji P (2010) Improving compliance and persistence to adjuvant tamoxifen and aromatase inhibitor therapy. Crit Rev Oncol Hematol 73:156–166PubMedCrossRefGoogle Scholar
  11. 11.
    Janicke F, Prechtl A, Thomssen C et al (2001) Randomized adjuvant chemotherapy trial in high-risk, lymph node-negative breast cancer patients identified by urokinase-type plasminogen activator and plasminogen activator inhibitor type 1. J Natl Cancer Inst 93:913–920PubMedCrossRefGoogle Scholar
  12. 12.
    Martin M, Pienkowski T, Mackey J et al (2005) Adjuvant docetaxel for node-positive breast cancer. N Engl J Med 352:2302–2313PubMedCrossRefGoogle Scholar
  13. 13.
    Moebus V, Jackisch C, Lueck HJ et al (2010) Intense dose-dense sequential chemotherapy with epirubicin, paclitaxel, and cyclophosphamide compared with conventionally scheduled chemotherapy in high-risk primary breast cancer: mature results of an AGO phase III study. J Clin Oncol 28:2874–2880PubMedCrossRefGoogle Scholar
  14. 14.
    Paik S, Shak S, Tang G et al (2004) A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 351:2817–2826PubMedCrossRefGoogle Scholar
  15. 15.
    Paik S, Tang G, Shak S et al (2006) Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol 24:3726–3734PubMedCrossRefGoogle Scholar
  16. 16.
    Perou CM, Sorlie T, Eisen MB et al (2000) Molecular portraits of human breast tumours. Nature 406:747–752PubMedCrossRefGoogle Scholar
  17. 17.
    Peto R, Davies C, Godwin J et al (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 379:432–444PubMedGoogle Scholar
  18. 18.
    Romond EH, Perez EA, Bryant J et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353:1673–1684PubMedCrossRefGoogle Scholar
  19. 19.
    Simon RM, Paik S, Hayes DF (2009) Use of archived specimens in evaluation of prognostic and predictive biomarkers. J Natl Cancer Inst 101:1446–1452PubMedCrossRefGoogle Scholar
  20. 20.
    Sorlie T, Perou CM, Tibshirani R et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A 98:10869–10874PubMedCrossRefGoogle Scholar
  21. 21.
    Sparano JA, Wang M, Martino S et al (2008) Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med 358:1663–1671PubMedCrossRefGoogle Scholar
  22. 22.
    Untch M, Loibl S, Bischoff J et al (2012) Lapatinib versus trastuzumab in combination with neoadjuvant anthracycline-taxane-based chemotherapy (GeparQuinto, GBG 44): a randomised phase 3 trial. Lancet Oncol 13:135–144PubMedCrossRefGoogle Scholar
  23. 23.
    Untch M, Rezai M, Loibl S et al (2010) Neoadjuvant treatment with trastuzumab in HER2-positive breast cancer: results from the GeparQuattro study. J Clin Oncol 28:2024–2031PubMedCrossRefGoogle Scholar
  24. 24.
    Van De Velde CJ, Rea D, Seynaeve C et al (2011) Adjuvant tamoxifen and exemestane in early breast cancer (TEAM): a randomised phase 3 trial. Lancet 377:321–331CrossRefGoogle Scholar
  25. 25.
    Von Minckwitz G, Eidtmann H, Loibl S et al (2011) Integrating bevacizumab, everolimus, and lapatinib into current neoadjuvant chemotherapy regimen for primary breast cancer. Safety results of the GeparQuinto trial. Ann Oncol 22:301–306CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Frauenklinik für Gynäkologie und GeburtshilfeUniversitätsklinikum Aachen, RWTHAachenDeutschland
  2. 2.Klinik und Poliklinik für Geburtshilfe und FrauenkrankheitenUniversitätsmedizin Mainz, Johannes Gutenberg-UniversitätMainzDeutschland

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