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Systemische Therapie des Mammakarzinoms

Systemic therapy for breast cancer

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Der Onkologe Aims and scope

Zusammenfassung

Ziel der adjuvanten Systemtherapie ist die Senkung der Mortalität durch Zerstörung von Mikrometastasen. Die Indikation ergibt sich aus einer individuellen Risiko-Nutzen-Abwägung anhand prognostischer und prädiktiver Faktoren. Beim Hormonrezeptor(HR)-positiven Mammakarzinom wird endokrin behandelt, Chemotherapie wird bei allen Hoch- und einem Teil der intermediären Risikopatienten eingesetzt. Die primär systemische Therapie ist beim inoperablen und inflammatorischen Mammakarzinom indiziert. In anderen Situationen kann sie alternativ zur adjuvanten Systemtherapie erfolgen, da sie bei gleichem Überleben häufiger die Brusterhaltung ermöglicht und die Effektivität der Therapie durch direktes Ansprechen des Tumors quantifizieren kann. Therapieziele im metastasierten Stadium sind Symptomkontrolle, Verbesserung der Lebensqualität und Lebensverlängerung. Beim HR-positiven, metastasierten Mammakarzinom erfolgt außer bei lebensbedrohender Erkrankung zuerst eine endokrine Therapie. Die Chemotherapie ist indiziert bei aggressiver oder endokrin-refraktärer Erkrankung. Bei her2/neu-Überexpression sollte bei metastasierter Erkrankung frühzeitig Trastuzumab eingesetzt werden. Bisphosphonate sind bei Knochenmetastasen indiziert.

Abstract

The aim of adjuvant systemic therapy is to destroy micrometastases and reduce mortality. The indications result from an individual risk/benefit calculation based on prognostic and predictive factors. Endocrine therapy is indicated in hormone receptor (HR) positive breast cancer, chemotherapy in high-risk and partly in intermediate-risk patients. Primary systemic therapy is indicated in inoperable and inflammatory breast cancer. It can be administered as an alternative to adjuvant treatment, because survival rates are similar but the breast conserving surgery rate is increased. The Tumor response to primary systemic therapy can predict long term out come of the patient. In metastatic breast cancer, systemic therapy is intended to control symptoms and to improve quality of life and survival. If there is no life-threatening disease, endocrine therapy is the first choice in HR positive breast cancer. Chemotherapy is used in rapidly progressive or endocrine-refractory disease. In case of Her2/neu overexpression, trastuzumab should be given early in the course of metastatic disease. Bisphosphonates are indicated if bone metastases are present.

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  1. Universitätsfrauenklinik, Heidelberg

    A. Schneeweiss & C. Sohn

  2. Universitätsfrauenklinik, Vossstraße 9, 69115 , Heidelberg

    A. Schneeweiss

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  1. A. Schneeweiss
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  2. C. Sohn
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Correspondence to A. Schneeweiss.

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Schneeweiss, A., Sohn, C. Systemische Therapie des Mammakarzinoms. Onkologe 11, 693–704 (2005). https://doi.org/10.1007/s00761-005-0893-6

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  • DOI: https://doi.org/10.1007/s00761-005-0893-6

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