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Current standards in the treatment of metastatic breast cancer with focus on Lapatinib: a review by a Central European Consensus Panel

Aktuelle Strategien in der Behandlung des metastasierten Mammakarzinoms mit dem Fokus auf Lapatinib: Ein Review eines Central European Consensus Panels

  • Consensus report
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Zusammenfassung

Sowohl Früherkennung als auch die Entwicklung neuer therapeutischer Optionen haben dazu geführt, dass bei Frauen mit Brustkrebs seltener ein metastasiertes Mammakarzinom diagnostiziert wird. Dennoch entwickelt etwa ein Drittel der Patienten, bei denen ein Mammakarzinom im frühen Stadium diagnostiziert wurde, irgendwann metastasierten Brustkrebs. Dazu kommt, dass ungefähr 25–30 % der Patienten mit Brustkrebs eine Überexpression des Wachstumsfaktors HER-2 aufweisen, der mit einem aggressiven Tumor-Phänotyp und schlechter Prognose assoziiert ist. Allerdings hat die Identifikation des HER-2-Proteins zur Entwicklung hoch effektiver Therapeutika geführt, die sich gegen diesen Rezeptor richten. Trastuzumab, ein rekombinanter, humanisierter, monoklonaler Antikörper, der an die extrazelluläre Domäne des HER-2-Proteins bindet, zeigte einen signifikanten Vorteil bei metastasiertem Brustkrebs und im frühen Stadium. Da es bei einigen Frauen nach adjuvanter Therapie zu einem Rezidiv kommt, und metastasierter Brustkrebs im Verlauf einer Trastuzumab-Therapie Resistenzen entwickeln kann, besteht Bedarf an alternativen Behandlungsoptionen, um die HER-2-Signalübertragung zu blockieren. Eine dieser Therapiemöglichkeiten ist Lapatinib, ein oral aktives kleines Molekül, das die Tyrosinkinase von HER-2 und den epidermalen Wachstumsfaktor-Rezeptor Typ 1 (EGFR) inhibiert. In diesem Konsensus-Statement werden die derzeitigen Behandlungsoptionen des metastasierten und lokal fortgeschrittenen Mammakarzinoms mit speziellem Fokus auf Lapatinib diskutiert.

Summary

In breast cancer, early detection as well as new developments in therapeutic options has resulted in less patients presenting with metastatic disease. However, about one-third of women with early stage breast cancer will eventually develop metastatic disease. Furthermore, approximately 20–30% of patients with breast cancer have tumors that overexpress human epidermal growth factor receptor (HER-2), which is associated with an aggressive tumor phenotype and poor prognosis. The identification of the HER-2 protein led to the development of highly effective therapeutics directed at this receptor. Trastuzumab, a recombinant, humanized, monoclonal antibody that binds to the extracellular domain of the HER-2 protein, has shown significant clinical benefit in metastatic and early-stage HER-2-positive breast cancer. Since the cancer recurs after adjuvant therapy in some women, and metastatic breast cancer eventually develops resistance to trastuzumab, there is a need for alternative treatment modalities to block HER-2 signaling. One of these treatment options is lapatinib, an orally active small molecule that inhibits the tyrosine kinases of HER-2 and the epidermal growth factor receptor type 1 (EGFR). In this consensus statement current treatment options in metastatic and locally advanced disease are discussed with a special focus on lapatinib.

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Authors and Affiliations

  1. Klinische Abteilung für Onkologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Austria

    Guenther G. Steger & Christoph C. Zielinski

  2. Fakultní Thomayerova nemocnice s poliklinikou, Onkologické oddělení, Praha, Czech Republic

    Jitka Abrahámová

  3. Spitalul Clinic "Sfanta Maria", Bucharest, Romania

    Florin Bacanu

  4. Sir Paul Boffa Hospital, Floriana, Malta

    Stephen Brincat

  5. Rīgas Austrumu Klīniskā Universitātes slimnīca (RAKUS), Riga, Latvia

    Arija Brize & Signe Plāte

  6. Chemoterapijos skyrius, Klaipėdos universitetinė ligoninė, Klaipėdos, Lithuania

    Alvydas Česas

  7. Univerzitetna Klinika Golnik, Golnik, Slovenia

    Tanja Čufer

  8. Semmelweis Egyetem Radiológiai és Onkotherápiás Klinika, Budapest, Hungary

    Magdolna Dank

  9. Klinika Onkologii, Wojskowy Instytut Medyczny, Warsaw, Poland

    Renata Duchnowska

  10. Institutul Oncologic "Ion Chiricuţă", Centrul de Tumori Mamare, Cluj-Napoca, România

    Alexandru Eniu

  11. Katedra i Klinika Onkologii I Radioterapii, Akademia Medyczna w Gdańsku, Poland

    Jacek Jassem

  12. Onkotherápiás Klinika, Szeged, Hungary

    Zsuzsanna Kahán

  13. Onkološki inštitut Ljubljana, Sektor za internistično onkologijo, Ljubljana, Slovenia

    Erika Matos

  14. Hematoloogia-Onkoloogia Kliinik, Tartu Ülikooli Kliinikum, Tartu, Estonia

    Peeter Padrik

  15. Keemiaravi osakond, Põhja-Eesti Regionaalhaigla Onkoloogiakeskus, Tallinn, Estonia

    Helis Pokker

  16. VSIA "Paula Stradina Klīniskā Universitātes slimnīca", Riga, Latvia

    Gunta Purkalne

  17. Klinika po Cimioterapia, Specializirana bolnica za aktivno lechenie po onkologia, Sofia, Bulgaria

    Constanta Timcheva

  18. Klinika po Chimioterapia, Universitetska bolnitza "Tzaritza Ioanna", Sofia, Bulgaria

    Valentina Tzekova

  19. Masarykuv onkologicky ustav, Brno, Czech Republic

    Rostislav Vyzula

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  1. Guenther G. Steger
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  2. Jitka Abrahámová
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  3. Florin Bacanu
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  4. Stephen Brincat
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  9. Renata Duchnowska
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  10. Alexandru Eniu
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  11. Jacek Jassem
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  12. Zsuzsanna Kahán
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  13. Erika Matos
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  14. Peeter Padrik
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  15. Signe Plāte
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  16. Helis Pokker
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  17. Gunta Purkalne
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  18. Constanta Timcheva
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  19. Valentina Tzekova
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  20. Rostislav Vyzula
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  21. Christoph C. Zielinski
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Correspondence to Guenther G. Steger.

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Steger, G., Abrahámová, J., Bacanu, F. et al. Current standards in the treatment of metastatic breast cancer with focus on Lapatinib: a review by a Central European Consensus Panel. Wien Klin Wochenschr 122, 368–379 (2010). https://doi.org/10.1007/s00508-010-1373-6

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  • DOI: https://doi.org/10.1007/s00508-010-1373-6

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