Update Mammakarzinom 2022 Teil 2 – Brustkrebs in fortgeschrittenen Krankheitsstadien

Zusammenfassung

Für Patientinnen mit einem fortgeschrittenen Mammakarzinom sind in den letzten Jahren mit den CDK4/6‑Inhibitoren, den Immuncheckpoint-Inhibitoren, den PARP-Inhibitoren, dem Alpelisib, Tucatinib und Trastuzumab-Deruxtecan sowie Sacituzumab-Govitecan einige Therapien neu etabliert worden, welche die Therapielandschaft von Patientinnen mit einem fortgeschrittenen Mammakarzinom deutlich verändert bzw. erweitert haben. Einige dieser Substanzen sind mittlerweile auch bei frühen Krankheitsstadien zugelassen bzw. eine Zulassung ist in naher Zukunft wahrscheinlich, sodass sich die Therapielandschaft abermals ändern wird. Die Einführung neuer Substanzen und das Verständnis der Progressions- und Effektivitätsmechanismen für diese Substanzen steht deswegen im Fokus der aktuellen wissenschaftlichen Bemühungen. In dieser Übersichtsarbeit werden die neuen Entwicklungen basierend auf aktuellen Publikationen und Kongressen zusammengefasst. Erkenntnisse zur Behandlung von Patientinnen mit einem HER2-positiven Mammakarzinom und Hirnmetastasen werden ebenso dargestellt wie eine Reihe von Studien, die sich mit Biomarkern bei Patientinnen mit HER2-negativem, hormonrezeptorpositivem Mammakarzinom beschäftigen. Insbesondere die Einführung der oralen, selektiven Östrogenrezeptor-Degradierer birgt neue Chancen, eine biomarkerbasierte Therapie zu etablieren. Die molekulare Diagnostik etabliert sich als diagnostischer Marker und Verlaufsparameter.

Abstract

For patients with advanced breast cancer, several novel therapies have emerged in recent years, including CDK4/6 inhibitors, immune checkpoint inhibitors, PARP inhibitors, alpelisib, tucatinib and trastuzumab-deruxtecan, and sacituzumab-govitecan, which have transformed and expanded the therapeutic landscape for patients with advanced breast cancer. Some of these substances have now been approved for use in the early stages of the disease, or are expected to be approved in the near future, so the therapeutic landscape will change once again. Therefore, current scientific efforts are focused on the introduction of new substances and understanding their mechanisms of progression and efficacy. This review summarizes recent developments with reference to recent publications and conferences. Findings on the treatment of patients with HER2-positive breast cancer and brain metastases are presented, as are a number of studies looking at biomarkers in patients with HER2-negative, hormone receptor-positive breast cancer. In particular, the introduction of oral selective estrogen receptor degraders provides new opportunities to establish biomarker-based therapy. Molecular diagnostics is establishing itself as a diagnostic marker and parameter of progression.

Schlüsselwörter

Brustkrebs - metastatisch - Biomarker - PD‑L1 - ADC

Key words

breast cancer - metastatic - biomarker - PD‑L1 - ADC

Publication History

Received: 21 March 2022

Accepted: 26 March 2022

Article published online:
06 December 2022

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