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Neoadjuvante Systemtherapie beim Mammakarzinom

Neoadjuvant system therapy for breast cancer

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Die neoadjuvante Therapie ist die Therapie der Wahl bei lokal fortgeschrittenen, primär inoperablen und inflammatorischen Karzinomen. Immer häufiger wird sie als Option für Frauen mit operablen Karzinomen, aber dem Wunsch nach weniger ausgedehnter Operation in Betracht gezogen. Es sollte ein Anthrazyklin und ein Taxan entweder simultan oder sequenziell über einen Zeitraum von mindestens 18 Wochen verabreicht werden. Patientinnen mit HER2-positiven Karzinomen sollten simultan zur Chemotherapie Trastuzumab erhalten. Bei der anschließenden Operation ist eine Resektion in den neuen Tumorgrenzen ausreichend. Die Effektivität der neoadjuvanten Therapie ist am Operationspräparat histomorphologisch bestimmbar und ist am größten, wenn keine invasiven oder nichtinvasiven Tumorresiduen in der Brust und den Lymphknoten gefunden werden. Die höchsten Remissionsraten verbunden mit günstiger Langzeitprognose werden bei triple-negativen bzw. HER2-positiven/Hormonrezeptor-negativen Karzinomen erzielt. Eine primäre Hormontherapie kann bei postmenopausalen Patientinnen mit rezeptorpositivem und Her2-negativem Tumor eingesetzt werden, bei denen eine Operation kontraindiziert ist oder die eine Operation ablehnen.

Abstract

Neoadjuvant therapy is the treatment of choice for patients with locally advanced, inoperable or inflammatory breast cancer. It is also increasingly being used for patients with operable tumors but the request for less extensive surgery. Neoadjuvant therapy should consist of an anthracycline and a taxane given either simultaneously or sequentially over a period of at least 18 weeks. Patients with HER2-positive tumors should simultaneously receive trastuzumab. Surgical resection of the tumor according to the new margins is considered sufficiently safe. Effectiveness of neoadjuvant therapy can be measured pathomorphologically in the resected tissue specimen and is optimal if no invasive or non-invasive tumor residuals are found either in the breast or in lymphatic tissue. The highest rates of remission correlating with the lowest relapse rates are observed in patients with triple negative or HER2-positive/hormone receptor negative carcinomas. Neoadjuvant endocrine therapy is an option for postmenopausal patients with hormone receptor positive/HER2-negative tumors, if surgery is generally contraindicated or declined.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Er hat Vortrags-/Beratungshonorare und finanzielle Forschungsunterstützung von Amgen, Cephalon, GSK, Novartis, Roche und Sanofi-Aventis erhalten. Für seinen Koautor (M.U.) gibt der korrespondierende Autor an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. German Breast Group, c/o GBG Forschungs GmbH, Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Deutschland

    G. von Minckwitz

  2. Frauenklinik, Interdisziplinäres Brustzentrum, Helios-Klinikum Berlin-Buch, Berlin-Buch, Deutschland

    M. Untch

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  1. G. von Minckwitz
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  2. M. Untch
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Correspondence to G. von Minckwitz.

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von Minckwitz, G., Untch, M. Neoadjuvante Systemtherapie beim Mammakarzinom. Gynäkologe 45, 453–459 (2012). https://doi.org/10.1007/s00129-011-2920-6

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  • DOI: https://doi.org/10.1007/s00129-011-2920-6

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