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DOI: 10.1055/s-0030-1262695
© Georg Thieme Verlag KG Stuttgart ˙ New York
Endokrine Therapie des Mammakarzinoms
Publication History
Publication Date:
13 December 2010 (online)
![](https://www.thieme-connect.de/media/frauenheilkunde-u2d/201006/lookinside/thumbnails/10.1055-s-0030-1262695-1.jpg)
Kernaussagen
Die endokrine Therapie ist integraler Bestandteil in der systemischen Therapie des hormonrezeptorpositiven Mammakarzinoms.
Standardtherapeutikum für die adjuvante Therapie der Patientin in der Prämenopause ist Tamoxifen (20 mg / Tag) über 5 Jahre. Möglicherweise profitieren Frauen unter 40 Jahren von einer zusätzlichen ovarablativen Therapie mit GnRH-Analoga über 2 Jahre.
In der adjuvanten Therapie des Mammakarzinoms werden in der Postmenopause die Aromatasehemmer der 3. Generation neben Tamoxifen eingesetzt. Sie zeigen im Vergleich zu Tamoxifen signifikante Vorteile in Bezug auf das rezidivfreie Überleben der Patientinnen. Die sequenzielle Gabe von Tamoxifen und Aromatasehemmern erzielte in einigen Studien auch eine Verbesserung der Gesamtüberlebenszeit. Welche Patientin von welcher Therapieoption profitiert, ist unklar. Der Behandlungszeitraum sollte aber in jedem Falle auch hier insgesamt 5 Jahre betragen. Nodalpositive Patientinnen profitieren von einer erweiterten adjuvanten Therapie.
In der palliativen Situation wird das Hauptaugenmerk auf die Lebensqualität gerichtet. Die endokrine Therapie steht als Systemtherapie im Vordergrund bei fehlender vitaler Bedrohung. Bei prämenopausalen Patientinnen ist die Therapie der Wahl die Ovarablation in Kombination mit Tamoxifen. Bei der postmenopausalen Patientin hängt die Wahl der endokrinen Therapie von den Vortherapien ab.
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Dr. med. M. Hellriegel
Universitätsmedizin Göttingen · Georg-August-Universität · Klinik für Frauenheilkunde und Geburtshilfe
Robert-Koch-Str. 40
37073 Göttingen
Email: martin.hellriegel@med.uni-goettingen.de