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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2019; 79(10): 1090-1099
DOI: 10.1055/a-1001-9952
GebFra Science
Review/Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Update Mammakarzinom 2019 Teil 5 – diagnostische und therapeutische Herausforderungen neuer personalisierter Therapien bei Patientinnen mit fortgeschrittenem Mammakarzinom

Article in several languages: English | deutsch
Manfred Welslau
1   Onkologie Aschaffenburg, Aschaffenburg, Germany
,
Andreas D. Hartkopf
2   Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
,
Volkmar Müller
3   Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
,
Achim Wöckel
4   Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
,
Michael P. Lux
5   Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Germany
,
Wolfgang Janni
6   Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
,
Johannes Ettl
7   Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
,
Diana Lüftner
8   Charité University Hospital, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin, Germany
,
Erik Belleville
9   ClinSol GmbH & Co KG, Würzburg, Germany
,
Florian Schütz
10   Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
,
Peter A. Fasching
11   Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
,
Hans-Christian Kolberg
12   Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
,
Naiba Nabieva
11   Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
,
Friedrich Overkamp
13   OncoConsult Hamburg GmbH, Hamburg, Germany
,
Florin-Andrei Taran
2   Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
,
Sara Y. Brucker
2   Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
,
Markus Wallwiener
10   Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
,
Hans Tesch
14   Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
,
Andreas Schneeweiss
15   National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital Heidelberg, Heidelberg, Germany
,
Tanja N. Fehm
16   Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
› Author Affiliations
Further Information

Publication History

received 24 July 2019
revised 04 August 2019

accepted 22 August 2019

Publication Date:
22 October 2019 (online)

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Zusammenfassung

Beim fortgeschrittenen Mammakarzinom sind in den letzten Jahren deutliche Fortschritte erzielt worden, diese fast alle auf dem Gebiet der zielgerichteten Therapie. Pertuzumab und Trastuzumab-Emtansin (T-DM1) konnten beim HER2-positiven Mammakarzinom eingeführt werden. Nun sind weitere Anti-HER2-Therapien in der Entwicklung (z. B. Margetuximab, DS-8201a, Pyrotinib), die weitere Resistenzmechanismen im HER2-Signalweg überwinden können. Auf dem Gebiet des hormonrezeptorpositiven Mammakarzinoms wurden in der Vergangenheit ein mTOR-Inhibitor und CDK4/6-Inhibitoren eingeführt. Nun steht die Einführung des ersten PI3K-Inhibitors bevor, die eine genetische Testung des Tumors auf eine Mutation im Gen PIK3CA mit sich bringen wird. Beim tripel-negativen Mammakarzinom gibt es ebenfalls deutliche Fortschritte: Durch Kombination von Chemo- plus Immuntherapie konnte ein Vorteil für das Gesamtüberleben in einer Subgruppe (Immunzellen PD-L1-positiv) gezeigt werden. Die PARP-Inhibitor-Therapie für HER2-negative Patientinnen mit einer Keimbahnmutation in BRCA1 oder BRCA2 war ebenfalls in einer Subgruppe mit einem verbesserten Gesamtüberleben assoziiert. Diese vielversprechenden, neuen Studienergebnisse werden in dieser Übersichtsarbeit zusammengefasst.

Schlüsselwörter

fortgeschrittenes Mammakarzinom - Metastasen - Therapien - Mutationstestungen - Immuntherapie
 

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