Update Mammakarzinom 2019 Teil 4 – diagnostische und therapeutische Herausforderungen neuer personalisierter Therapien für Patientinnen mit frühem Mammakarzinom

Florian Schütz; Peter A. Fasching; Manfred Welslau; Andreas D. Hartkopf; Achim Wöckel; Michael P. Lux; Wolfgang Janni; Johannes Ettl; Diana Lüftner; Erik Belleville; Hans-Christian Kolberg; Friedrich Overkamp; Florin-Andrei Taran; Sara Y. Brucker; Markus Wallwiener; Hans Tesch; Tanja N. Fehm; Andreas Schneeweiss; Volkmar Müller

doi:10.1055/a-1036-0961

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

Senologie - Zeitschrift für Mammadiagnostik und -therapie 2019; 16(04): 281-291
DOI: 10.1055/a-1036-0961

Wissenschaftliche Arbeit

Update Mammakarzinom 2019 Teil 4 – diagnostische und therapeutische Herausforderungen neuer personalisierter Therapien für Patientinnen mit frühem Mammakarzinom

Update Breast Cancer 2019 Part 4 – Diagnostic and Therapeutic Challenges of New, Personalised Therapies for Patients with Early Breast Cancer

Authors

Florian Schütz

¹Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg
Peter A. Fasching

²Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen
Manfred Welslau

³Onkologie Aschaffenburg, Aschaffenburg
Andreas D. Hartkopf

⁴Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
Achim Wöckel

⁵Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg
Michael P. Lux

⁶Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten
Wolfgang Janni

⁷Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm
Johannes Ettl

⁸Department of Obstetrics and Gynecology, Klinikumrechts der Isar, Technical University of Munich, Munich
Diana Lüftner

⁹Charité University Hospital, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumor Immunology, Berlin
Erik Belleville

¹⁰ClinSol GmbH & Co KG, Würzburg
Hans-Christian Kolberg

¹¹Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop
Friedrich Overkamp

¹²OncoConsult Hamburg GmbH, Hamburg
Florin-Andrei Taran

⁴Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
Sara Y. Brucker

⁴Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
Markus Wallwiener

¹Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg
Hans Tesch

¹³Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt
Tanja N. Fehm

¹⁴Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf
Andreas Schneeweiss

¹⁵National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital Heidelberg, Heidelberg
Volkmar Müller

¹⁶Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg

Abstract

Zusammenfassung

Die Weiterentwicklung der Therapien für Frauen mit einem frühen Mammakarzinom schreitet deutlich langsamer voran als bei Patientinnen mit fortgeschrittenem Mammakarzinom und ist zudem zeitlich versetzt zu Entwicklungen beim metastasierten Mammakarzinom. Trotzdem konnten in letzter Zeit deutliche Fortschritte verzeichnet werden. Diese Übersichtsarbeit fasst die jüngsten Entwicklungen vor dem Hintergrund der neuesten Publikationen und Fachkongresse zusammen. Für hormonrezeptorpositive Patientinnen sind neue Aspekte für die Dauer der Antihormontherapie und in Bezug auf den Nutzen von Multigentests veröffentlicht worden. Bei HER2-positiven Patientinnen werden der Stellenwert einer post-neoadjuvanten Therapie und eine Deeskalation der Therapie diskutiert. Bei Patientinnen mit tripel-negativem Mammakarzinom stellt sich die Frage, ob das Wissen um den biologischen Hintergrund einer Defizienz der homologen Rekombination (HRD) dabei hilft, neue Therapien für diesen Subtyp zu entwickeln. Insbesondere die „Nutzung“ einer BRCA1/2-Mutation oder des biologischen Merkmals HRD als potenzielles Therapiemotiv spielen eine Rolle dabei, den Stellenwert der Platintherapie und einer Therapie mit PARP-Inhibitoren zu spezifizieren.

Abstract

The further development of therapies for women with early breast cancer is progressing far more slowly than in the case of patients with advanced breast cancer and is additionally delayed compared to developments in metastatic breast cancer. Nonetheless, significant advancements have been able to be recorded recently. This review summarises the latest developments in view of the most recent publications and professional conferences. For hormone-receptor-positive patients, new aspects for the duration of antihormone therapy and with regard to the benefits of multigene tests have been published. In the case of HER2-positive patients, the value of post-neoadjuvant therapy and de-escalation of the therapy is discussed. In patients with triple-negative breast cancer, there is a question of whether the knowledge of the biological background of a homologous recombination deficiency (HRD) helps develop new therapies for this subtype. In particular the “use” of a BRCA1/2 mutation or the biological characteristic HRD as a potential motive for therapy plays a role here in specifying the significance of platinum therapy and therapy with PARP inhibitors.

Schlüsselwörter

Mammakarzinom - adjuvant - neoadjuvant - Chemotherapie - Antihormontherapie - Multigentests

Key words

breast cancer - adjuvant - neoadjuvant - chemotherapy - antihormone therapy - multigene tests

Full Text

References

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