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Senologie - Zeitschrift für Mammadiagnostik und -therapie 2024; 21(04): 289-312
DOI: 10.1055/a-2305-1411
Wissenschaftliche Arbeit

Identifizierung von Patientinnen mit HR+, HER2– Brustkrebs im Frühstadium mit hohem Rezidivrisiko

Identification of Patients with Early HR+ HER2– Breast Cancer at High Risk of Recurrence
Peter A. Fasching
1   Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, Germany
,
Hans Kreipe
2   Institute of Pathology, Hannover Medical School, Hannover, Germany
,
Lucia Del Mastro
3   S. S. Sviluppo Terapie Innovative, Department of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy
4   Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
,
Eva Ciruelos
5   SOLTI Breast Cancer Research Group, Barcelona, Spain
6   Hospital Universitario 12 de Octubre, Madrid, Spain
7   Centro Integral Oncológico Clara Campal HM (CIOCC), Madrid, Spain
,
Gilles Freyer
8   Oncology Department, CITOHL, Lyon-Sud Hospital, Cancer Institute of Hospices Civils de Lyon (IC‑HCL), Hospices Civils de Lyon, Lyon, France
9   Lyon-Sud Medicine School, University of Lyon, University Claude Bernard Lyon 1, Lyon, France
,
Agnieszka Korfel
10   Lilly Deutschland GmbH, Bad Homburg, Germany
,
Nadia Chouaki
11   Eli Lilly and Company, Neuilly-sur-Seine, France
,
Clemens Stoffregen
10   Lilly Deutschland GmbH, Bad Homburg, Germany
,
Francisco Sapunar
12   Eli Lilly and Company Limited, Windlesham, Surrey, UK
,
David Cameron
13   University of Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, Western General Hospital, Edinburgh, UK
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Zusammenfassung

Die Inzidenz von Brustkrebs ist in den letzten 2 Jahrzehnten gestiegen; gleichzeitig hat sich das Überleben durch eine frühere Erkennung und bessere Therapiemöglichkeiten verbessert. Trotz dieser Verbesserungen treten lokoregionäre Rezidive sowie Fernmetastasen bei bis zu 10 resp. 30 % aller mit Brustkrebs im Frühstadium diagnostizierten Frauen auf. Rund 70 % aller Brustkrebsfälle sind HR+ (hormonrezeptorpositiv), HER2– (humaner epidermaler Wachstumsfaktor-Rezeptor-2-negativ) und somit mit einem anhaltenden Rezidivrisiko assoziiert, das bis zu 20 Jahre nach der Diagnose/Erstbehandlung anhält. Wir führten eine narrative Übersichtsarbeit durch und kombinierten dabei unsere Suche in PubMed mit unseren klinischen Erfahrungen, um die Patientinnen-Charakteristika, Biomarker und Instrumente zur Analyse von Genomprofilen zu beschreiben, die Klinik-Ärztinnen und ‑ärzten zur Identifizierung von Patientinnen mit HR+, HER2– frühem Mammakarzinom mit einem hohen Rezidivrisiko zur Verfügung stehen, und um Empfehlungen zur Klassifizierung von Patientinnen gemäß ihrem Rezidivrisiko aufzustellen. Es wurden auch nationale und internationale Behandlungsrichtlinien zusammengefasst. Die korrekte Einschätzung des Rezidivrisikos ist für diese Patientinnen wichtig, weil das prognostizierte Risiko die nachfolgenden Therapie-Entscheidungen steuern wird; unpräzise Einschätzungen können zur Über- bzw. Untertherapie führen, und beide Szenarien haben negative Konsequenzen für die Patientinnen. Es gibt zahlreiche prognostische Werkzeuge und Faktoren, die für die Analyse von Brustkrebs im Frühstadium empfohlen werden; es gibt aber keinen Test, der für sich genommen eine akkurate Prognose bieten kann. Da es keinen Test gibt, der für sich allein genommen imstande ist, eine akkurate Prognose zu bieten, sollte eine Kombination verschiedener Testverfahren verwendet werden. Risikoschwellen sind wichtig, da diese die Entscheidung für eine optimierte, ausgewogene Therapie bei HR+, HER2– frühem Mammakarzinom lenkt. Dennoch sollte jede prognostische Evaluierung individuell durchgeführt werden, da ein patientenspezifisches prognostisches Vorgehen wichtig ist, um eine Über- oder Untertherapie zu vermeiden.

Abstract

Breast cancer incidence has increased in the last 2 decades and, simultaneously, survival has improved due to earlier detection and improved treatment options. Despite this improvement, locoregional recurrences and distant metastases occur in up to 10 and 30 % of women diagnosed with early breast cancer, respectively. Around 70 % of breast cancers are hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2–), and associated with a persistent risk of relapse up to 20 years after diagnosis/initial treatment. We conducted a narrative review by combining PubMed searches with our clinical experience to describe patient characteristics, biomarkers, and genomic profiling tools available to clinicians for the identification of patients with HR+, HER2– early breast cancer at high risk of recurrence and to provide recommendations to classify patients into recurrence risk categories. National and international treatment guidelines are also summarized. Accurate assessment of the risk of recurrence in these patients is crucial as the predicted risk guides treatment decisions; imprecise estimations can result in over- or undertreatment, with either scenario having negative consequences for patients. Multiple prognostic tools and factors are recommended for early breast cancer, and no single test provides accurate prognosis in isolation. Since no single test can provide accurate prognosis in isolation, a combination of tools should therefore be used. Risk thresholds are important to guide optimized and balanced therapeutic decisions in HR+, HER2– early breast cancer. However, prognostic assessment should be performed on a case-by-case basis, making patient-specific prognostic approaches essential to avoid over- or undertreatment.

Schlüsselwörter

Brustkrebs im Frühstadium - HR+ - HER2– - Rezidivrisiko - Risikoprognose

Keywords

early breast cancer - HR+ - HER2– - risk of recurrence - prediction of risk


Publication History

Received: 15 December 2023

Accepted after revision: 23 December 2023

Article published online:
09 December 2024

© 2024. This article was originally published by Thieme in Geburtsh Frauenheilk 2024; 84: 164–184 as an open access article 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 commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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