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DOI: 10.1055/s-2007-981267
© Georg Thieme Verlag Stuttgart · New York
Systemische Behandlung des Brustkrebses des Mannes
Systemic Therapy of Male Breast CancerPublication History
Publication Date:
01 October 2007 (online)
![](https://www.thieme-connect.de/media/zblchir/200705/lookinside/thumbnails/10.1055-s-2007-981267-1.jpg)
Zusammenfassung
Die Datenlage zur Bewertung systemischer Behandlungsmaßnahmen beim Brustkrebs des Mannes ist wegen der relativ geringen Inzidenz dieses Tumors sehr dürftig. Prospektive, randomisierte Studien fehlen sowohl in der adjuvanten als auch in der metastasierten Therapiesituation. Retrospektive Analysen umfassen sehr kleine Patientenzahlen, die meist in jahrelangen Erfassungsphasen zusammen gestellt wurden. Prinzipiell bestehen zwischen dem Brustkrebs der Frau und des Mannes hinsichtlich epidemiologischer Daten, zellulären Rezeptorkonzentrationen, genetischer Besonderheiten und Genpolymorphismen erhebliche Unterschiede, sodass es nicht ohne weiteres gerechtfertigt ist, die Behandlungsergebnisse des Brustkrebses der Frau auf das Mammakarzinom des Mannes zu übertragen. Hormonelle Therapieverfahren sind zwar gut wirksam, doch scheint ihre Effektivität möglicherweise aufgrund unterschiedlicher biologischer Faktoren trotz hoher Östrogenrezeptorkonzentrationen etwas niedriger zu liegen als bei der Frau. Der antihormonelle Therapiestandard ist heute der Einsatz von Tamoxifen. Ob die Effektivität einer Tamoxifentherapie einer Orchiektomie gleichzusetzen ist, ist unbekannt. Sie wird allerdings wegen der geringen Toxizität klinisch bevorzugt. Beim Einsatz von Aromatasehemmern ist Vorsicht geboten, da zwar die Aromatisierungsreaktion blockiert wird, nicht aber die 5α-Reduktase, die bei Aromatase-induzierten erhöhten Testosteronkonzentrationen zur vermehrten Bildung von östrogenartig wirkenden Androstandiolen führt. Ob die zusätzliche Gabe von GnRH-Analoga und / oder von 5α-Reduktasehemmern bessere Behandlungsergebnisse erbringt, ist unklar. Durch den kombinierten Einsatz von GnRH-Analoga und Antiandrogenen lassen sich Tumorremissionen bewirken. Vergleiche mit anderen antihormonellen Behandlungsformen bestehen nicht. Geprüft wird gegenwärtig die Wirksamkeit von Fulvestrant, einer Substanz, die zum vermehrten Abbau von Östrogenrezeptoren führt. Zytostatische Therapien scheinen beim Brustkrebs des Mannes ähnlich gut wirksam wie bei der Frau.
Abstract
Due to its low incidence there is only few information on optimal systemic therapy of male breast cancer. There are no prospective randomized trials, neither for early breast cancer nor for advanced stages. Retrospective analyses mostly comprise long-term-data from a small number of patients. In terms of epidemiology, cellular receptors or genetics there exist some significant differences between male and female breast cancer. Therefore, the possibility to extrapolate treatment recommendation for male patients from female breast cancer-trials is limited. Despite a high rate of receptor positivity, hormonal therapy seems to be less efficient in men, possibly due to different biological factors. The current standard in endocrine therapy is tamoxifen. It is not known whether tamoxifen therapy is as effective as orchiectomy, but tamoxifen is favoured because of its low side effects. The use of aromatase inhibitors needs to be considered carefully, since aromatization is blocked, but 5-alpha-reductase increases estrogen-like androstanediole. There might be a benefit from additional therapy with GnRH-analoga respectively 5-alpha-reductase inhibitors, but data is not available yet. Combination of GnRH-analoga and antiandrogens does induce tumor remission, but comparison to other endocrine therapies is still lacking. Currently, the efficiency of fulvestrant, an estrogen receptor destructor, is being examined. Cytostatic therapy seems to be as effective as in female breast cancer patients. Nevertheless, convincing prospective trials for the management of early and advanced male breast cancer need to be performed.
Schlüsselwörter
Mammakarzinom - Mann - Hormontherapie - Chemotherapie
Key words
male - breast cancer - systemic therapy - endocrine treatment - chemotherapy
Literatur
- 1 American Cancer Society .Cancer facts and figures 2005. American Cancer Society, Atlanta (GA) 2005
- 2 Bagley C S, Wesley M N, Young R C. et al . Adjuvant chemotherapy in males with cancer of the breast. Am J Clin Oncol. 1987; 10 55-60
- 3 Doberauer C, Niederle N, Schmidt C. Advanced male breast cancer treatment with the LHRH analogue buserelin alone or in combination with the anti-androgen flutamide. Cancer. 1998; 62 474-478
- 4 Dukes M, Edwards P N, Large M. et al . The preclinical pharmacology of “Arimidex” (anastrozole; ZD 1033) - a potent, selective aromatase inhibitor. J Steroid Biochem Mol Biol. 1996; 58 439-445
- 5 Ellinwood W E, Hess D L, Roselli C E. et al . Inhibition of aromatization stimulates luteinizing hormone and testosterone secretion in adult male rhesus monkeys. J Clin Endocrinol Metab. 1984; 59 1088-1096
- 6 Farrell J, Adair F. Effect of orchiectomy on skeletal metastases from cancer of the male breast. Science. 1941; 95 654-657
- 7 Giordano S H. A review of the diagnosis and management of male breast cancer. The Oncologist. 2005; 10 471-479
- 8 Giordano S, Cohen D, Buzdar A. et al . Breast carcinoma in men: a population-based study. Cancer. 2004; 101 51-57
- 9 Giordano S H, Perkins G H, Broglio K, Gracia S G, Middleton L P, Buzdar A U, Hortobagyi G N. Adjuvant systemic therapy for male breast carcinoma. Cancer. 2005; 104 2359-2364
- 10 Giordano S H, Valero V, Buzdar A. et al . Efficacy of anastrozole in male breast cancer. Am J Clin Oncol. 2002; 25 235-237
- 11 Goss P E, Reid C, Pintilie M. et al . Male breast carcinoma: a review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1955-1996. Cancer. 1999; 85 629-639
- 12 Harris A L, Dowsett M, Stuart-Harris R. et al . Role of aminoglutethimide in male breast cancer. Br J Cancer. 1986; 54 657-660
- 13 Jaiyesimi I A, Buzdar A U, Sahin A A. et al . Carcinoma of the male breast. Ann Internal Med. 1992; 117 771-777
- 14 Juniewicz P E, Oesterling J E, Walters J R. et al . Aromatase inhibition in the dog. I. Effect on serum LH, serum testosterone concentrations, testicular secretions and spermatogenesis. J Urol. 1988; 139 827-831
- 15 Lopez M, Barduagni A. Cyproterone acetate in advanced male breast cancer. Cancer. 1982; 49 9-11
- 16 Lopez M, DiLauro L, Lazzaro B. et al . Hormonal treatment of disseminated male breast cancer. Oncology. 1985; 42 345-349
- 17 Muir D, Kanthan R, Kanthan S C. Male versus female breast cancers. A population-based comparative immunohistochemical analysis. Arch Pathol Lab Med. 2003; 127 36-41
- 18 Munoz de Toro M M, Maffini M V, Kass L. et al . Proliferative activity and steroid hormone receptor status in male breast carcinoma. J Steroid Biochem Mol Biol. 1998; 67 333-339
- 19 Pannuti F, Martoni A, Busutti L. High-dose medroxyprogesterone acetate in advanced male breast cancer. Cancer Treat Rep. 1982; 66 1763-1765
- 20 Patterson J S, Battersby L A, Bach B K. Use of tamoxifen in advanced male breast cancer. Cancer Treat Rep. 1980; 64 801-804
- 21 Rayson D, Erlichman C, Suman V J. et al . Molecular markers in male breast carcinoma. Cancer. 1998; 83 1947-1955
- 22 Roselli C E, Resko J A. Sex differences in androgen-regulated expression of cytochrome P 450 aromatase in the rat brain. J Steroid Biochem Mol Biol. 1997; 61 365-374
- 23 Riberio G G. The results of diethylstilbestrol therapy for recurrent and metastatic carcinoma of the male breast. Br J Cancer. 1976; 33 465-467
- 24 Shetty G, Krishnamurthy H, Bhatnagar A S. et al . Effect of long-term treatment with aromatase inhibitor on testicular function of adult male bonnet monkeys (M. radiata). Steroids. 1998; 63 414-420
- 25 Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER Stat Database .Incidence-SEER Regs Public-Use; November 2004 submission (1973-2002). National Cancer Institute, DCPPS, Surveillance Research Program, Cancer Statistics Branch, released April 2005, based on the November 2004 submission
- 26 Treves N, Abels J C, Woodard H Q, Farrow J H. The effects of orchiectomy on primary and metastatic carcinoma of the breast. Surg Gynecol Obst. 1944; 79 589-605
- 27 Vorobiof D A, Falkson G. Nasally administered buserelin inducing complete remission of lung metastases in male breast cancer. Cancer. 1987; 59 688-689
- 28 Wang-Rodriguez J, Cross K, Gallagher S. Male breast carcinoma: correlation of ER, PR, Ki-67, HER-2 Neu, and P 53 with treatment and survival, a study of 65 cases. Mod Pathol. 2002; 15 853-861
- 29 Weber-Chappuis K, Bieri-Burger S, Hurlimann. Comparison of prognostic markers detected by immunohistochemistry in male and female breast carcinomas. Europ J Cancer. 1996; 32 A 1688-1692
- 30 Weber-Chappuis K, Bieri-Burger S, Hurlimann. Male and female breast carcinomas. Eur J Cancer. 1996; 32 1686-1692
- 31 Yildirim E, Berberoglu U. Male breast cancer: a 22-year experience. Eur J Surg Oncol. 1998; 24 548-552
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