Zusammenfassung
Aromatasehemmer wurden in klinischen Studien als Ersatz und als Additivum der Standardtherapie mit Tamoxifen untersucht. In prospektiv-randomisierten Studien konnte für Anastrozol, Letrozol und Exemestan eine Steigerung der Ansprechraten, eine signifikante Verlängerung des progressionsfreien Intervalls und eine Verbesserung der Gesamtüberlebensrate bei postmenopausalen Patientinnen mit metastasiertem Mammakarzinom nachgewiesen werden. In den letzten Jahren wurde versucht, diese Therapeutika in die adjuvante Phase einzuführen. Die ATAC-Studie zeigte, dass Anastrozol bei Frauen mit steroidrezeptorpositiven Tumoren gegenüber Tamoxifen die Rate an Lokal- und an Fernrezidiven signifikant senken kann. Zwei weitere Studien haben den sequenziellen Einsatz von Tamoxifen und Letrozol bzw. Exemestan untersucht. Nach 2,4 Jahren Nachbeobachtungszeit zeigte sich ein signifikanter Vorteil für Letrozol bezüglich des rezidivfreien Überlebens. Auch in einem sequenziellen Therapieansatz mit Tamoxifen und Exemestan konnte eine Reduktion an Lokal- und Fernrezidiven sowie kontralateralen Mammakarzinomen nachgewiesen werden. Im Gesamtüberleben wiesen diese Studien keine Unterschiede zwischen den Therapiearmen auf.
Abstract
Aromatase inhibitors have replaced tamoxifen as first choice in postmenopausal women with steroid receptor-positive disease. A series of prospective randomized trials demonstrated that anastrozole, letrozole, and exemestane are superior to tamoxifen in terms of therapy response, progression-free survival, and overall survival. Recent large clinical trials have examined these therapeutic agents in the adjuvant setting. The ATAC trial demonstrated that anastrozole significantly reduces both the rates of local and distant recurrences among women with steroid receptor-positive disease in comparison to tamoxifen. Two other large clinical trials examined the sequential use of tamoxifen and letrozole and exemestane. After a median follow-up of 2.4 years, letrozole proved superior in terms of recurrences. Also, exemestane after tamoxifen leads to a significant reduction of recurrences and contralateral breast cancers. There was no difference in overall survival in both studies.
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Tempfer, C., Riener, EK. & Keck, C. Aromatasehemmer in der endokrinen Therapie des Mammakarzinoms . Gynäkologische Endokrinologie 2, 149–152 (2004). https://doi.org/10.1007/s10304-004-0070-9
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DOI: https://doi.org/10.1007/s10304-004-0070-9