Diagnostik und Therapie des triple-negativen Mammakarzinoms (TNBC) – Empfehlungen für die tägliche Routine

Andreas Schneeweiss; Carsten Denkert; Peter A. Fasching; Carlo Fremd; Oleg Gluz; Cornelia Kolberg-Liedtke; Sibylle Loibl; Hans-Joachim Lück

doi:10.1055/a-0977-4248

Senologie - Zeitschrift für Mammadiagnostik und -therapie, Table of Contents

Senologie - Zeitschrift für Mammadiagnostik und -therapie 2019; 16(03): 219-231
DOI: 10.1055/a-0977-4248

Wissenschaftliche Arbeit

Diagnostik und Therapie des triple-negativen Mammakarzinoms (TNBC) – Empfehlungen für die tägliche Routine

Diagnosis and Therapy of Triple-Negative Breast Cancer (TNBC) – Recommendations for Daily Routine Practice

Andreas Schneeweiss

¹Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum, Heidelberg

²Deutsches Krebsforschungszentrum, Heidelberg

,

Carsten Denkert

³Institut für Pathologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg

,

Peter A. Fasching

⁴Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen

,

Carlo Fremd

¹Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum, Heidelberg

,

Oleg Gluz

⁵Brustzentrum Niederrhein, Evangelisches Krankenhaus Bethesda, Mönchengladbach

⁶Westdeutsche Studiengruppe, Mönchengladbach

,

Cornelia Kolberg-Liedtke

⁷Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin

,

Sibylle Loibl

⁸German Breast Group c/o GBG Forschungs GmbH, Neu-Isenburg

⁹Zentrum für Hämatologie und Onkologie Bethanien, Goethe Universität Frankfurt, Frankfurt am Main

,

Hans-Joachim Lück

¹⁰Gynäkologie Onkologie, Gynäkologisch-onkologische Praxis, Hannover

› Author Affiliations

Abstract

Zusammenfassung

Durch den raschen Erkenntnisgewinn zu Tumorbiologie und Tumorpathogenese des triple-negativen Mammakarzinoms (TNBC) ergeben sich neue Therapieansätze und neue Therapiekonzepte für die Behandlung. Seit Jahren gilt das TNBC wegen seiner in der Regel aggressiven Tumorbiologie und angesichts limitierter Therapieoptionen als schwierig zu behandelnder Tumor. Das Rezidiv- und Metastasierungsrisiko ist höher als bei anderen Mammakarzinom-Subtypen desselben Stadiums. Neben Operation und Bestrahlung in der kurativen Situation ist die systemische Chemotherapie mit Anthrazyklinen und/oder Taxanen nach wie vor die Therapie der Wahl. Neue Therapieansätze basieren auf der Erkenntnis, dass das TNBC eine molekular sehr heterogene Erkrankung ist. Forschungsgruppen arbeiten daran, das TNBC immer besser auf molekularer Ebene zu klassifizieren und diese molekulare Subtypisierung als Grundlage für neue therapeutische Strategien zu nutzen. Im Folgenden werden die vielversprechendsten neuen Ansätze und Überlegungen zur Therapie des TNBCs dargestellt. Anhand einer fiktiven Kasuistik werden zudem die derzeitigen Therapiestrategien unter Berücksichtigung der aktuellen Datenlage und den sich daraus ergebenden therapeutischen Konsequenz besprochen.

Abstract

The rapid increase in knowledge in tumour biology and tumour pathogenesis of triple-negative breast cancer (TNBC) has resulted in new therapeutic approaches and new therapeutic concepts for treatment. For years, TNBC has been considered to be a difficult-to-treat tumour due to its generally aggressive tumour biology and in view of limited therapeutic options. The risk of recurrence and metastasis is higher than in the case of other breast cancer subtypes of the same stage. In addition to surgery and radiation in the curative situation, systemic chemotherapy with anthracyclines and/or taxanes is still the therapy of choice. New therapeutic approaches are based on the knowledge that TNBC is a molecularly very heterogeneous disease. Research groups are working to classify TNBC better and better on a molecular level and use this molecular subtyping as the basis for new therapeutic strategies. The most promising new approaches and considerations regarding the therapy of TNBCs are shown below. In addition, the current therapeutic strategies are discussed using a fictitious case history, taking the current data and the resultant therapeutic consequence into account.

Schlüsselwörter

triple‑negatives Mammakarzinom - BRCA‑Mutation - Subtypisierung des TNBC - Diagnostik und Therapie des TNBC

Key words

triple‑negative breast cancer - BRCA mutation - subtyping of TNBC - diagnosis and therapy of TNBC

Full Text

References

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