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Postneoadjuvante Therapie – Zukünftige Konzepte

Postneoadjuvant therapy—future concepts

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Der Gynäkologe Aims and scope

Zusammenfassung

Eine primär systemische Therapie (PST) eröffnet die Möglichkeit, die Effektivität der Behandlung patientenindividuell in situ zu evaluieren. Patientinnen, die eine pathologische Komplettremission (pCR) erreichen, haben eine deutlich verbesserte Prognose. Hieraus können personalisierte Therapiemodifikationen abgeleitet werden. CREATE‑X und KATHERINE sind die ersten klinischen Studien, die ein derartiges Therapiekonzept in die klinische Praxis überführen. Durch die postneoadjuvante Behandlung von TNBC(„triple-negative breast cancer“)-Patientinnen mit Capecitabin bzw. HER2-positiven Patientinnen mit Trastuzumab-DM1 bei non-pCR verbessert sich die Prognose signifikant. In Zukunft sollte auch untersucht werden, inwieweit die PST zur Deeskalation der Systemtherapie genutzt werden kann. Gleichzeitig müssen prognostische und prädiktive Marker entwickelt werden, welche diejenigen Patientinnen identifizieren, die von einer postneoadjuvanten Therapieeskalation tatsächlich profitieren.

Abstract

Primary systemic therapy (PST) offers the possibility of evaluating treatment efficacy at an individual-patient level in situ. As pathological complete response (pCR) is significantly associated with an improved prognosis, personalized treatment modifications can be derived from this. CREATE‑X and KATHERINE are the first clinical trials that transfer such a therapeutic concept into clinical practice. Among patients who do not achieve a pCR, postneoadjuvant treatment of triple-negative patients with capecitabine and HER2-positive patients with trastuzumab-DM1 significantly improves prognosis. In the future, it should be investigated whether PST can also be used to de-escalate systemic treatment. At the same time, prognostic and predictive markers must be developed to identify those patients who actually benefit from postneoadjuvant treatment escalation.

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Authors and Affiliations

  1. Department für Frauengesundheit, Universitäts-Frauenklinik Tübingen, Calwerstr. 7, 72076, Tübingen, Deutschland

    Andreas D. Hartkopf & Eva-Maria Grischke

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  1. Andreas D. Hartkopf
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  2. Eva-Maria Grischke
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Correspondence to Andreas D. Hartkopf.

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Interessenkonflikt

A.D. Hartkopf hat Vortragshonorare, Beratungshonorare und Reisekosten von der Firma Roche erhalten. E.-M. Grischke gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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A. Wöckel, Würzburg

S.Y. Brucker, Tübingen

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Hartkopf, A.D., Grischke, EM. Postneoadjuvante Therapie – Zukünftige Konzepte. Gynäkologe 53, 292–299 (2020). https://doi.org/10.1007/s00129-020-04588-1

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