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State of the Art der endokrinen Therapie des metastasierten Mammakarzinoms

State of the art endocrine treatment for metastatic breast cancer

  • Leitthema
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Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Das metastasierte Mammakarzinom ist nach aktuellem Kenntnisstand nicht heilbar. Insofern ist das Ziel der Therapie neben einer Lebensverlängerung vor allem die Erhaltung einer guten Lebensqualität und Vermeidung von Symptomen. Die Therapiemodalität der Wahl für alle rezeptorpositiven Patientinnen, die nicht wegen rasch fortschreitender Erkrankung mit massiver Symptomatik einer Chemotherapie bedürfen, ist die endokrine Therapie. Hier sind die Aromatasehemmer Substanzen der ersten Wahl sowohl für die Tamoxifen-naive Patientin als auch für die Patientin, die adjuvant Tamoxifen erhalten hat. Dabei ist zu berücksichtigen, dass steroidale Aromatasehemmer auch nach Versagen der nichtsteroidalen Substanzen ein Ansprechen zeigen und umgekehrt, sodass diese Substanzen sequenziell eingesetzt werden können. Im nächsten Therapieschritt kann bei der Tamoxifen-naiven Patientin Tamoxifen zur Anwendung kommen. In der Sequenz danach hat bei weiterem Progress der Östrogenrezeptorantagonist Fulvestrant seinen Platz, gefolgt von den Gestagenen. In der prämenopausalen Situation ist der Nutzen der Anwendung von GnRH-Analoga, kombiniert mit Tamoxifen, belegt. Die weitere Therapie ist unter Beibehaltung der ovariellen Suppression aus den Daten in der postmenopausalen Situation extrapoliert, die Therapieschritte entsprechen sich.

Abstract

According to current knowledge metastatic breast cancer (MBC) is an incurable disease. Therefore, the focus of treatment is on improving quality of life and palliating symptoms besides prolonging survival. Endocrine therapy is the modality of choice for all ER- or PR-positive patients not requiring chemotherapy for rapidly progressive disease with massive symptoms. Aromatase inhibitors are the first choice in MBC for tamoxifen-naïve patients as well as for patients who have received adjuvant tamoxifen. Steroidal and nonsteroidal aromatase inhibitors can be used sequentially. The next step for the tamoxifen-naïve patient would be tamoxifen. Based on new data the antiestrogen fulvestrant is the next step in this algorithm, followed by the progestins. In the premenopausal situation a benefit from the combination of LHRH analogues and tamoxifen has been shown. Further therapy steps are extrapolated from the postmenopausal situation always in combination with ovarian suppression.

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Interessenkonflikt:

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: Regional Advisory Board Astra Zeneca, Beratervertrag Pfizer, regelm. Vortragstätigkeit Novartis.

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

    H.-C. Kolberg, M. Löning, D. Diesing, M. Friedrich & K. Diedrich

  2. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 , Lübeck

    H.-C. Kolberg

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  1. H.-C. Kolberg
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Correspondence to H.-C. Kolberg.

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Kolberg, HC., Löning, M., Diesing, D. et al. State of the Art der endokrinen Therapie des metastasierten Mammakarzinoms. Gynäkologische Endokrinologie 3, 85–90 (2005). https://doi.org/10.1007/s10304-005-0103-z

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