Update Mammakarzinom 2019 Teil 2 – Implementierung neuer Diagnostika und Therapien bei Patientinnen mit fortgeschrittenem Brustkrebs in der klinischen Praxis

Wolfgang Janni; Andreas Schneeweiss; Volkmar Müller; Achim Wöckel; Michael P. Lux; Andreas D. Hartkopf; Naiba Nabieva; Florin-Andrei Taran; Hans Tesch; Friedrich Overkamp; Diana Lüftner; Erik Belleville; Florian Schütz; Peter A. Fasching; Tanja N. Fehm; Hans-Christian Kolberg; Johannes Ettl

doi:10.1055/a-0982-9906

TumorDiagnostik & Therapie, Table of Contents

TumorDiagnostik & Therapie 2019; 40(07): 445-458
DOI: 10.1055/a-0982-9906

Thieme Onkologie aktuell

Update Mammakarzinom 2019 Teil 2 – Implementierung neuer Diagnostika und Therapien bei Patientinnen mit fortgeschrittenem Brustkrebs in der klinischen Praxis

Update Breast Cancer 2019 Part 2 – Implementation of Novel Diagnostics and Therapeutics in Advanced Breast Cancer Patients in Clinical Practice

Authors

Wolfgang Janni

¹Department of Gynecology and Obstetrics, Ulm University-Hospital, Ulm
Andreas Schneeweiss

²National Center for Tumor Diseases, Division Gynecologic Oncology, University-Hospital Heidelberg, Heidelberg
Volkmar Müller

³Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg
Achim Wöckel

⁴Department of Gynecology and Obstetrics, University-Hospital Würzburg, Würzburg
Michael P. Lux

⁵Erlangen University-Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen
Andreas D. Hartkopf

⁶Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
Naiba Nabieva

⁵Erlangen University-Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen
Florin-Andrei Taran

⁶Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
Hans Tesch

⁷Oncology Practice at Bethanien-Hospital Frankfurt, Frankfurt
Friedrich Overkamp

⁸OncoConsult Hamburg GmbH, Hamburg
Diana Lüftner

⁹Charité University-Hospital, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin
Erik Belleville

¹⁰ClinSol GmbH & Co KG, Würzburg
Florian Schütz

¹¹Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg
Peter A. Fasching

⁵Erlangen University-Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen
Tanja N. Fehm

¹²Department of Gynecology and Obstetrics, University-Hospital Düsseldorf, Düsseldorf
Hans-Christian Kolberg

¹³Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop
Johannes Ettl

¹⁴Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich

Abstract

Zusammenfassung

Die Behandlung von Patientinnen mit fortgeschrittenem Mammakarzinom hat sich in den letzten Jahren weiterentwickelt. Zusätzlich zum Therapiefortschritt in den etablierten Subgruppen (Hormonrezeptor- und HER2-Status) gibt es nun Therapien, die sich an einzelnen molekularen Charakteristika orientieren, wie zum Beispiel die PARP-Inhibitor-Therapie bei BRCA-mutierten Patientinnen. Zusätzlich dazu sind Tests in der Entwicklung, die innerhalb von Subgruppen weitere Marker etablieren sollen, um die Wirksamkeit einer Therapie vorherzusagen. Die PI3K-Mutationstestung bei HER2-negativen, hormonrezeptorpositiven Tumoren und die PD‑L1-Testung von Immunzellen bei triple-negativen Tumoren werden voraussichtlich in der klinischen Praxis etabliert, um Patientinnen für die jeweiligen Therapien auszuwählen. Mit neuen Therapieansätzen treten auch neue Nebenwirkungen auf. Das Management dieser Nebenwirkungen ebenso wie die der klassischen Therapien (supportive Therapie) ist mit der Einführung neuer Behandlungen essenziell, um die Lebensqualität der Patientinnen zu erhalten. Das Wissen über Maßnahmen zur Erhaltung und Verbesserung der Lebensqualität hat in den letzten Jahren deutlich zugenommen. Lifestyle-Faktoren sollten dabei ebenso Berücksichtigung finden wie moderne Therapieverfahren. Diese Übersichtsarbeit fasst die neuesten Studien und Veröffentlichungen zusammen und bewertet sie in Bezug auf die Relevanz für die klinische Praxis.

Abstract

The treatment of patients with advanced breast cancer has developed further in recent years. In addition to therapeutic progress in the established subgroups (hormone receptor and HER2 status), there are now therapies which are geared to individual molecular characteristics, such as PARP inhibitor therapy in BRCA-mutated patients. In addition to this, tests are being developed which are intended to establish additional markers within subgroups in order to predict the efficacy of a therapy. PI3K mutation testing in HER2-negative, hormonereceptor-positive tumours and PD‑L1 testing of immune cells in triple-negative tumours are expected to become established in clinical practice in order to select patients for the respective therapies. With new therapeutic approaches, new adverse effects also appear. The management of these adverse effects, just as those of classical therapy (supportive therapy), is essential with the introduction of new treatments in order to preserve patientsʼ quality of life. Knowledge regarding measures to preserve and improve quality of life has significantly increased in recent years. Lifestyle factors should be taken into account, as should modern therapeutic methods. This review summarises the latest studies and publications and evaluates them in regard to the relevance for clinical practice.

Schlüsselwörter

Mammakarzinom - Metastasen - fortgeschritten - PI3K - PD‑L1 - Alpelisib - Atezolizumab - PARP - Supportivtherapie

Key words

breast cancer - metastatic - advanced - PI3K - PD‑L1 - alpelisib - atezolizumab - PARP - supportive therapy

Full Text

References

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