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Der Klinikarzt 2015; 44(2): 105-110
DOI: 10.1055/s-0035-1547511
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Das metastasierte Mammakarzinom – Medikamentöse Therapie individuell nach Patientin und Tumor

Metastatic breast cancer – Drug therapy individually according to patient and tumor
Andreas Schneeweiss
1   Nationales Centrum für Tumorerkrankungen, Universitäts-Klinikum Heidelberg
,
Christian Jackisch
2   Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach
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Publication History

Publication Date:
10 March 2015 (online)

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Das metastasierte Mammakarzinom (metastatic breast cancer, MBC) ist eine chronisch-progredient verlaufende, nicht heilbare Erkrankung. Primäre Therapieziele sind die Erhaltung oder Verbesserung der Lebensqualität und die Minderung tumorbedingter Beschwerden. Die Therapiewahl muss sich an Alter, Allgemeinzustand, Komorbiditäten, Vortherapien, der Aggressivität der Erkrankung und den individuellen Wünschen und Bedürfnissen der Patienten orientieren. Als Systemtherapien stehen zytostatische, endokrine und neue zielgerichtete Therapien zur Verfügung. Eine Systemtherapie sollte jeweils bis zum eindeutigen Progress der Erkrankung oder dem Auftreten intolerabler Nebenwirkungen fortgeführt werden. Erst dann sollte eine Therapieumstellung erfolgen. Bei positivem Hormonrezeptorstatus sollte primär eine endokrine Therapie verabreicht werden. Bei hormonrezeptornegativem Mammakarzinom, endokriner Resistenz, starken Beschwerden oder rascher Progredienz ist die palliative Chemotherapie indiziert. Beim MBC zugelassene zielgerichtete, d. h. über definierte Moleküle wirksame Wirkstoffe, sind neben den endokrinen Therapien die monoklonalen Antikörper Trastuzumab, Pertuzumab und Bevacizumab, das Immunotoxin Trastuzumab-Emtansine sowie die Kinaseinhibitoren Lapatinib und Everolimus. Bei HER-Überexpression sollte eine gegen HER2 gerichtete Therapie Teil der Systemtherapie sein. Bei Knochenmetastasen sind zur Vermeidung skelettaler Komplikationen Bisphosphonate oder Denosumab indiziert. Die umfassende molekulare Charakterisierung des individuellen Tumors und der Patientin wird uns in Zukunft eine besser auf die einzelne Patientin und ihre Erkrankung zugeschnittene Therapie ermöglichen.

Metastatic breast cancer (MBC) is a chronically progressing incurable disease. Primary aims of therapy are to maintain or improve quality of life and to reduce tumor-related symptoms. Treatment choice must be based on age, performance status, comorbidities, previous treatments, aggressiveness of disease and the wishes and needs of the individual patient. Available systemic treatments are chemotherapies, endocrine and new targeted therapies. Each systemic therapy should be continued until disease progression or the occurrence of intolerable side effects. Only then therapy should be changed. In case of hormone receptor expression endocrine therapy is the first-line treatment of choice. In case of hormone receptor negative breast cancer, endocrine resistance or rapid progression palliative chemotherapy is indicated. In addition to endocrine treatments approved targeted drugs against defined molecules in MBC are the monoclonal antibody trastuzumab, pertuzumab and bevacizumab, the immunotoxin trastuzumab emtansine and the kinase inhibitors lapatinib and everolimus. In case of HER overexpression an anti-HER2 therapy should be part of the treatment. To prevent skeletal complications bisphosphonates or denosumab are indicated in patients with bone metastases. In the future the comprehensive molecular characterization of the individual tumor and patient will allow us to better personalize treatment to the individual patient and her disease.

Key words

Metastatic breast cancer (MBC) - quality of life - Treatment choice - systemic treatments - chemotherapies - endocrine therapy - new targeted therapies - palliative chemotherapy - anti-HER2 therapy - molecular characterization - personalize treatment
 

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