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Hochdosischemotherapie beim Mammakarzinom

High-dose chemotherapy for breast cancer

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Weder in der adjuvanten noch in der palliativen Behandlungssituation konnte bisher eine klare Überlegenheit der Hochdosischemotherapie (HDCT) gegenüber den bestmöglichen konventionellen Therapien nachgewiesen werden. Für die adjuvante Therapie zeigte lediglich eine von 14 Studien einen signifikanten Überlebensvorteil nach HDCT, wobei am ehesten jüngere Frauen sowie Patientinnen mit ≥10 befallenen Lymphknoten oder Her2/neu-negativen Tumoren von einer HDCT profitieren. In der metastasierten Situation konnten zwar 4 von 6 Studien ein längeres progressionsfreies Überleben demonstrieren, ohne dass dies jedoch mit einem Überlebensvorteil einherging. Die Interpretation der bisherigen Studien wird durch geringe Fallzahlen, uneinheitliche und z. T. intensivierte konventionelle Behandlungsarme und den Einsatz ungeeigneter Zytostatika erschwert. Verschiedene Ansätze wie das Konzept der frühen Intensivierung sind nicht ausreichend untersucht. Bis zum Nachweis eines klaren Vorteils sollte in Anbetracht der erhöhten Morbidität und Mortalität der Einsatz der HDCT randomisierten Studien vorbehalten sein.

Abstract

The role of high-dose chemotherapy (HDCT) in breast cancer remains controversial. Randomized trials have failed to show a clear benefit in either primary or metastatic breast cancer. In the adjuvant setting, only 1 of 14 trials has demonstrated a survival benefit, although subset analyses indicate a potential benefit for younger women or women with more than ten involved lymph nodes or HER2-negative tumors. In metastatic breast cancer, four of six randomized trials demonstrated prolonged progression-free survival with HDCT. This did however not translate into a survival benefit. Several issues such as lack of statistical power, use of dose-intensive chemotherapy regimens in the control arm, or inappropriate selection of cytotoxic agents with only moderate activity and/or unacceptable toxicity have made the interpretation of the current trials difficult. Furthermore, alternative HDCT approaches such as early intensification or tandem HDCT have not been evaluated sufficiently. In view of the lack of a clear benefit and the increased treatment-associated morbidity and mortality, HDCT should currently only be used within clinical trials.

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  1. Charing Cross and Hammersmith Hospital, Imperial College London, Fulham Palace Road, W6 8RF, London, United Kingdom

    P. Schmid

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Schmid, P. Hochdosischemotherapie beim Mammakarzinom. Onkologe 13, 409–424 (2007). https://doi.org/10.1007/s00761-006-1090-y

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