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DOI: 10.1055/a-1483-2782
Behandlung von Patientinnen mit frühem Mammakarzinom: Evidenz, Kontroversen, Konsens
Meinungsbild deutscher Expert*Innen zur 17. Internationalen St.-Gallen-Konsensuskonferenz Artikel in mehreren Sprachen: English | deutschZusammenfassung
Die diesjährige 17. St.-Gallen-(SG-)Konsensus-Konferenz zur Behandlung von Patientinnen mit frühem Mammakarzinom (SG-BCC) stand unter dem Motto „Customizing local and systemic therapies for women with early breast cancer“ und fokussierte auf die Herausforderung, die Behandlung des frühen Mammakarzinoms zielgerichteter auf die individuelle Krankheitssituation adaptieren. Wie schon in den vergangenen Jahren hat auch dieses Jahr eine deutsche Arbeitsgruppe führender Brustkrebsexpert*Innen die Ergebnisse der internationalen SG-BCC 2021 vor dem Hintergrund der deutschen Therapieempfehlungen für den Klinikalltag in Deutschland diskutiert. Der Vergleich der SG-Empfehlungen mit den erst kürzlich aktualisierten Therapieempfehlungen der Kommission Mamma der Arbeitsgemeinschaft Gynäkologische Onkologie e. V. (AGO) sowie der S3-Leitlinie ist hilfreich, da sich das SG-BCC-Panel aus Experten unterschiedlicher Länder zusammensetzt, weshalb länderspezifische Besonderheiten in die SG-Empfehlungen einfließen können. Die deutschen Therapieempfehlungen der AGO sowie der S3-Leitlinie basieren auf der aktuellen Evidenz. Gleichwohl muss jede Therapieentscheidung immer einer Nutzen-Risiko-Abwägung für die individuelle Situation unterzogen und mit der Patientin besprochen werden.
Schlüsselwörter
St.-Gallen-Konsensus 2021 - frühes Mammakarzinom - Operation - Strahlentherapie - (neo)adjuvante Systemtherapie - zielgerichtete Therapie* Writing Committee
** Steering Committee
# St. Gallen Panel Expert
Publikationsverlauf
Eingereicht: 08. April 2021
Angenommen nach Revision: 20. April 2021
Artikel online veröffentlicht:
19. Mai 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References/Literatur
- 1 AGO Kommission Mamma. Diagnostik und Therapie früher und fortgeschrittener Mammakarzinome (März 2021). Accessed April 18, 2021 at: https://www.ago-online.de/fileadmin/ago-online/downloads/_leitlinien/kommission_mamma/2021/Alle_aktuellen_Empfehlungen_2021.pdf
- 2 Interdisziplinäre S3-Leitlinie für die Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms [Langversion 4.3 Februar 2020). Accessed April 18, 2021 at: https://www.awmf.org/uploads/tx_szleitlinien/032-045OLl_S3_Mammakarzinom_2020-02.pdf
- 3 Breast International Group. Olaparib as Adjuvant Treatment in Patients With Germline BRCA Mutated High Risk HER2 Negative Primary Breast Cancer (OlympiA). Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT02032823
- 4 Nielsen TO, Leung SCY, Rimm DL. et al. Assessment of Ki67 in Breast Cancer: Updated Recommendations from the International Ki67 in Breast Cancer Working Group. J Natl Cancer Inst 2020; DOI: 10.1093/jnci/djaa201.
- 5 Fasching PA, Gass P, Häberle L. et al. Prognostic effect of Ki-67 in common clinical subgroups of patients with HER2-negative, hormone receptor-positive early breast cancer. Breast Cancer Res Treat 2019; 175: 617-625 DOI: 10.1007/s10549-019-05198-9.
- 6 Wiesner FG, Magener A, Fasching PA. et al. Ki-67 as a prognostic molecular marker in routine clinical use in breast cancer patients. Breast 2009; 18: 135-141 DOI: 10.1016/j.breast.2009.02.009.
- 7 Dettmar P, Harbeck N, Thomssen C. et al. Prognostic impact of proliferation-associated factors MIB1 (Ki-67) and S-phase in node-negative breast cancer. Br J Cancer 1997; 75: 1525-1533 DOI: 10.1038/bjc.1997.261.
- 8 Harbeck N, Gluz O, Kuemmel S. et al. Neoadjuvant nab-paclitaxel weekly versus dose-dense paclitaxel followed by dose-dense EC in high risk HR+/HER2- early BC by: Results from the neoadjuvant part of ADAPT HR+/HER2- trial. San Antonio Breast Cancer Symposium 2020; Abstract No. GS4-03.
- 9 Smith I, Robertson J, Kilburn L. et al. Long-term outcome and prognostic value of Ki67 after perioperative endocrine therapy in postmenopausal women with hormone-sensitive early breast cancer (POETIC): an open-label, multicentre, parallel-group, randomised, phase 3 trial. Lancet Oncol 2020; 21: 1443-1454 DOI: 10.1016/S1470-2045(20)30458-7.
- 10 German Breast Group. A Study Comparing Atezolizumab (Anti PD-L1 Antibody) In Combination With Adjuvant Anthracycline/Taxane-Based Chemotherapy Versus Chemotherapy Alone In Patients With Operable Triple-Negative Breast Cancer (IMpassion030). Accessed April 18, 2021 at: https://www.clinicaltrials.gov/ct2/show/NCT03498716
- 11 NSABP Foundation Inc., German Breast Group. Clinical Trial of Neoadjuvant Chemotherapy With Atezolizumab or Placebo in Patients With Triple-Negative Breast Cancer Followed After Surgery by Atezolizumab or Placebo – GeparDouze (GBG 96). Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT03281954
- 12 Study to Compare a Mono Atezolizumab Window Followed by a Atezolizumab – CTX Therapy With Atezolizumab – CTX Therapy (neoMono). Accessed April 18, 2021 at: http://www.clinicaltrials.gov/ct2/show/NCT04770272?term=neomono&draw=2&%20rank=1
- 13 European Breast Cancer Reseach Association of Surgical Trialists. AXillary Surgery After NeoAdjuvant Treatment (AXSANA). Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT04373655
- 14 Kuemmel S, Heil J, Rueland A. et al. A Prospective, Multicenter Registry Study to Evaluate the Clinical Feasibility of Targeted Axillary Dissection (TAD) in Node-Positive Breast Cancer Patients. Ann Surg 2020; DOI: 10.1097/SLA.0000000000004572.
- 15 Caudle AS, Yang WT, Krishnamurthy S. et al. Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection. J Clin Oncol 2016; 34: 1072-1078 DOI: 10.1200/JCO.2015.64.0094.
- 16 Giuliano AE, Ballman KV, McCall L. et al. Effect of Axillary Dissection vs. No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA 2017; 318: 918-926 DOI: 10.1001/jama.2017.11470.
- 17 Donker M, van Tienhoven G, Straver ME. et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 2014; 15: 1303-1310 DOI: 10.1016/S1470-2045(14)70460-7.
- 18 NSABP Foundation Inc.. Standard or Comprehensive Radiation Therapy in Treating Patients With Early-Stage Breast Cancer Previously Treated With Chemotherapy and Surgery. Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/study/NCT01872975
- 19 Brunt AM, Haviland J, Sydenham M. et al. FAST Phase III RCT of Radiotherapy Hypofractionation for Treatment of Early Breast Cancer: 10-Year Results (CRUKE/04/015). International Journal of Radiation Oncology*Biology*Physics 2018; 102: 1603-1604 DOI: 10.1016/j.ijrobp.2018.08.049.
- 20 Murray Brunt A, Haviland JS, Wheatley DA. et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. The Lancet 2020; 395: 1613-1626 DOI: 10.1016/S0140-6736(20)30932-6.
- 21 Krug D, Baumann R, Combs SE. et al. Moderate hypofractionation remains the standard of care for whole-breast radiotherapy in breast cancer: Considerations regarding FAST and FAST-Forward. Strahlenther Onkol 2021; 197: 269-280 DOI: 10.1007/s00066-020-01744-3.
- 22 Strnad V, Krug D, Sedlmayer F. et al. DEGRO practical guideline for partial-breast irradiation. Strahlenther Onkol 2020; 196: 749-763 DOI: 10.1007/s00066-020-01613-z.
- 23 Evron E, Ben-David AM, Goldberg H. et al. Prophylactic irradiation to the contralateral breast for BRCA mutation carriers with early-stage breast cancer. Ann Oncol 2019; 30: 412-417 DOI: 10.1093/annonc/mdy515.
- 24 Krug D, Baumann R, Budach W. et al. Commercially Available Gene Expression Assays as Predictive Tools for Adjuvant Radiotherapy? A Critical Review. Breast Care (Basel) 2020; 15: 118-126 DOI: 10.1159/000505656.
- 25 van der Noordaa ME, Yau C, Shad S. et al. Assessing prognosis after neoadjuvant therapy: A comparison between anatomic ypAJCC staging, Residual Cancer Burden Class and Neo-Bioscore. San Antonio Breast Cancer Symposium 2020; Abstract No. GS4-07.
- 26 Mittendorf EA, Vila J, Tucker SL. et al. The Neo-Bioscore Update for Staging Breast Cancer Treated With Neoadjuvant Chemotherapy: Incorporation of Prognostic Biologic Factors Into Staging After Treatment. JAMA Oncol 2016; 2: 929-936 DOI: 10.1001/jamaoncol.2015.6478.
- 27 Jeruss JS, Mittendorf EA, Tucker SL. et al. Combined use of clinical and pathologic staging variables to define outcomes for breast cancer patients treated with neoadjuvant therapy. J Clin Oncol 2008; 26: 246-252 DOI: 10.1200/JCO.2007.11.5352.
- 28 von Minckwitz G, Huang C-S, Mano MS. et al. Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med 2019; 380: 617-628 DOI: 10.1056/NEJMoa1814017.
- 29 German Breast Group. Sacituzumab Govitecan in Primary HER2-negative Breast Cancer (SASCIA). Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT04595565
- 30 McCormick B, Winter K, Hudis C. et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol 2015; 33: 709-715 DOI: 10.1200/JCO.2014.57.9029.
- 31 Chua BH, Link E, Kunkler I. et al. GS2-04. A randomized phase III study of radiation doses and fractionation schedules in non-low risk ductal carcinoma in situ (DCIS) of the breast (BIG 3-07/TROG 07.01). San Antonio Breast Cancer Symposium 2020; Abstract No. GS2-04.
- 32 Wang S-L, Fang H, Song Y-W. et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol 2019; 20: 352-360 DOI: 10.1016/S1470-2045(18)30813-1.
- 33 Danish Breast Cancer Cooperative Group. Hypofractionated Loco-regional Adjuvant Radiation Therapy of Breast Cancer Combined With a Simultaneous Integrated Boost. Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT02384733
- 34 Alliance for Clinical Trials in Oncology. Hypofractionated Radiation Therapy After Mastectomy in Preventing Recurrence in Patients With Stage II a-III a Breast Cancer. Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT03414970
- 35 Dana-Farber Cancer Institute. Study of Radiation Fractionation on Patient Outcomes After Breast REConstruction (FABREC) for Invasive Breast Carcinoma. Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT03422003
- 36 M.D. Anderson Cancer Center. Hypofractionated vs. Conventional Regional Nodal Radiation Therapy for Patients With Invasive Breast Cancer. Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT02912312
- 37 Marta GN, Ramiah D, Kaidar-Person O. et al. The Financial Impact on Reimbursement of Moderately Hypofractionated Postoperative Radiation Therapy for Breast Cancer: An International Consortium Report. Clin Oncol (R Coll Radiol) 2020; DOI: 10.1016/j.clon.2020.12.008.
- 38 Krug D, Vonthein R, Schreiber A. et al. Impact of guideline changes on adoption of hypofractionation and breast cancer patient characteristics in the randomized controlled HYPOSIB trial. Strahlenther Onkol 2020; DOI: 10.1007/s00066-020-01730-9.
- 39 Kunkler I, Williams LJ, Jack W. et al. GS2-03. Prime 2 randomised trial (postoperative radiotherapy in minimum-risk elderly): Wide local excision and adjuvant hormonal therapy +/- whole breast irradiation in women =/> 65 years with early invasive breast cancer: 10 year results. San Antonio Breast Cancer Symposium 2020; Abstract No. GS2-03.
- 40 Vaidya JS, Wenz F, Bulsara M. et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 2014; 383: 603-613 DOI: 10.1016/S0140-6736(13)61950-9.
- 41 Vaidya JS, Bulsara M, Baum M. et al. Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. BMJ 2020; 370: m2836 DOI: 10.1136/bmj.m2836.
- 42 OʼShaughnessy JA, Johnston S, Harbeck N. et al. Primary outcome analysis of invasive disease-free survival for monarchE: abemaciclib combined with adjuvant endocrine therapy for high risk early breast cancer. San Antonio Breast Cancer Symposium 2020; Abstract No. GS1-01.
- 43 Cardoso F, vanʼt Veer LJ, Bogaerts J. et al. 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. N Engl J Med 2016; 375: 717-729 DOI: 10.1056/NEJMoa1602253.
- 44 Sparano JA, Gray RJ, Della Makower F. et al. Prospective Validation of a 21-Gene Expression Assay in Breast Cancer. N Engl J Med 2015; 373: 2005-2014 DOI: 10.1056/NEJMoa1510764.
- 45 Kalinsky K, Barlow WE, Meric-Bernstam F. et al. First results from a phase III randomized clinical trial of standard adjuvant endocrine therapy (ET) +/- chemotherapy (CT) in patients (pts) with 1 – 3 positive nodes, hormone receptor-positive (HR+) and HER2-negative (HER2-) breast cancer (BC) with recurrence score (RS) < 25: SWOG S1007 (RxPonder). San Antonio Breast Cancer Symposium 2020; Abstract No. GS3-00.
- 46 West German Study Group. Adj. Dyn. Marker-adjusted Personalized Therapy Comparing Abemaciclib + SOC ET vs. SOC ET in Clinical or Genomic High Risk, HR+/HER2- EBC (ADAPTlate). Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT04565054
- 47 West German Study Group. Adj. Marker-adjusted Personalized Therapy Comparing ET+Ribociclib vs. Chemotherapy in Intermediate Risk, HR+/HER2- EBC (ADAPTcycle). Accessed April 18, 2021 at: https://clinicaltrials.gov/ct2/show/NCT04055493
- 48 Gonzalez-Angulo AM, Litton JK, Broglio KR. et al. High risk of recurrence for patients with breast cancer who have human epidermal growth factor receptor 2-positive, node-negative tumors 1 cm or smaller. J Clin Oncol 2009; 27: 5700-5706 DOI: 10.1200/JCO.2009.23.2025.
- 49 Kang Y-J, Oh SJ, Choi H. et al. Clinical significance of HER2 status in T1 bN0 breast cancer: a nationwide study from the Korean Breast Cancer Society. Breast Cancer Res Treat 2021; 186: 125-134 DOI: 10.1007/s10549-020-06017-2.
- 50 Cancello G, Maisonneuve P, Rotmensz N. et al. Prognosis in women with small (T1mic,T1a,T1b) node-negative operable breast cancer by immunohistochemically selected subtypes. Breast Cancer Res Treat 2011; 127: 713-720 DOI: 10.1007/s10549-011-1465-7.
- 51 Villasco A, Actis S, Borella F. et al. Evaluation of the efficacy of Trastuzumab in patients with HER2 positive small (pT1mi/a) breast cancers. A multicenter retrospective study on 100 patients. The Breast 2021; 56: S17-S18 DOI: 10.1016/S0960-9776(21)00090-4.
- 52 Reimer T, Stachs A, Nekljudova V. et al. Restricted Axillary Staging in Clinically and Sonographically Node-Negative Early Invasive Breast Cancer (c/iT1–2) in the Context of Breast Conserving Therapy: First Results Following Commencement of the Intergroup-Sentinel-Mamma (INSEMA) Trial. Geburtshilfe Frauenheilkd 2017; 77: 149-157 DOI: 10.1055/s-0042-122853.
- 53 Cold S, Cold F, Jensen M-B. et al. 1814 Vaginal estrogens and risk of recurrence or death in women treated for estrogen receptor positive breast cancer. Eur J Cancer 2015; 51: S270 DOI: 10.1016/S0959-8049(16)30766-3.
- 54 Smetanay K, Junio P, Feißt M. et al. COOLHAIR: a prospective randomized trial to investigate the efficacy and tolerability of scalp cooling in patients undergoing (neo)adjuvant chemotherapy for early breast cancer. Breast Cancer Res Treat 2019; 173: 135-143 DOI: 10.1007/s10549-018-4983-8.
- 55 Rugo HS, Voigt J. Scalp Hypothermia for Preventing Alopecia During Chemotherapy. A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Breast Cancer 2018; 18: 19-28 DOI: 10.1016/j.clbc.2017.07.012.
- 56 Nangia J, Wang T, Osborne C. et al. Effect of a Scalp Cooling Device on Alopecia in Women Undergoing Chemotherapy for Breast Cancer: The SCALP Randomized Clinical Trial. JAMA 2017; 317: 596-605 DOI: 10.1001/jama.2016.20939.