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Endokrine antihormonelle Therapie in der Prämenopause

Traitement endocrinien antihormonal dans la préménopause

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Journal für Gynäkologische Endokrinologie/Schweiz Aims and scope

Zusammenfassung

Aktuelle Studien haben die Möglichkeiten der Therapie eines prämenopausalen Mammakarzinoms verändert und die Therapieleitlinien der internationalen und nationalen senologischen Gesellschaften ergänzt. Bei prämenopausalen Patientinnen mit niedrigem Rezidivrisiko ohne Chemotherapie bleibt Tamoxifen erste Wahl, wobei bei guter Verträglichkeit nach 5 Jahren die Verlängerung der Therapie mit Tamoxifen auf weitere 5 Jahre erwogen werden kann (individuelle, risikoadaptierte Entscheidung). Sollte die Patientin nach der TAM-Therapie in der Postmenopause sein, wäre eine Therapie mit Aromatasehemmer (AI) für weitere 5 Jahre empfehlenswert. Bei prämenopausalen Patientinnen mit hohem Rezidivrisiko, die eine Chemotherapie benötigen und nach der Chemotherapie noch prämenopausal sind, ist die Therapie mit Exemestan + Ovarian Function Suppression (OFS) (GnRH-Analoga) für 5 Jahre vorteilhaft (auch für Patientinnen mit einer Kontraindikation gegen Tamoxifen (TAM) [z. B. Thrombosen] optional). Bei Unverträglichkeit oder intolerablen Nebenwirkungen stellt die Kombination TAM + OFS eine Alternative dar. Für Patientinnen mit niedrigem Risiko und Kinderwunsch kann auch eine zeitreduzierte Therapieoption mit TAM + GnRH-Analogon Goserelin ± Zoledronsäure für 3 Jahre besprochen werden (ABCSG 12).

Résumé

Des études récentes ont modifié les possibilités dans le traitement du cancer du sein préménopausique et complété les directives thérapeutiques des sociétés internationales et nationales de sénologie. Le tamoxifène reste l’option de première intention chez les patientes préménopausiques ayant un faible risque de récidive sans chimiothérapie. Si le tamoxifène a été bien toléré pendant 5 ans, ce traitement peut alors être poursuivi 5 ans de plus (décision au cas par cas, adaptée au risque individuel). Chez les patientes ayant atteint la postménopause à la fin du traitement par le tamoxifène, un traitement par un inhibiteur de l’aromatase (IA) est recommandé les 5 années suivantes. Chez les patientes préménopausiques qui ont un risque élevé de récidive, ont besoin d’une chimiothérapie et n’ont pas encore atteint la ménopause à la fin de la chimiothérapie, un traitement de 5 ans par l’exémestane + SFO (suppression de la fonction ovarienne, analogues de la GnRH) est un bon choix (c’est aussi une option chez les patientes pour lesquelles le tamoxifène [TAM] est contre-indiqué [p.ex. thromboses]). Lors d’intolérance au traitement ou d’effets indésirables inacceptables, l’association TAM + SFO est une alternative. Chez les patientes à faible risque qui souhaitent encore avoir un enfant, on peut envisager une option thérapeutique de durée réduite par TAM + goséréline (analogue de la GnRH) ± acide zolédronique sur 3 ans (ABCSG 12).

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Authors and Affiliations

  1. Brustambulanz, Brustgesundheitszentrum, Universitätsklinik für Frauenheilkunde, Währinger Gürtel 18–20, 1090, Wien, Österreich

    Leo Auerbach

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L. Auerbach gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Dieser Beitrag wird auch im Journal für Gynäkologische Endokrinologie/Österreich 2017, https://doi.org/10.1007/s41974-017-0022-8 veröffentlicht.

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Auerbach, L. Endokrine antihormonelle Therapie in der Prämenopause. J. Gynäkol. Endokrinol. 20, 151–156 (2017). https://doi.org/10.1007/s41975-017-0023-z

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