Neue Strategien der Systemtherapie beim HER2-positiven metastasierten Mammakarzinom

Zusammenfassung

Die HER2-Positivität ist prädiktiv für das Ansprechen auf Anti-HER2-gerichtete Therapien. Durch die Entwicklung neuer Anti-HER2-Strategien verbessert sich die Behandlung von HER2-positiven Tumoren stetig, sodass mittlerweile eine Vielzahl verschiedener Anti-HER2-Therapien verfügbar ist, welche die Substanzklassen der Anti-HER2-Antikörper, Tyrosinkinase-Inhibitoren (TKI) und Antikörper-Wirkstoff-Konjugate (ADC) umfassen. Die bevorzugte Erstlinien-Therapie bleibt die Kombination aus Trastuzumab, Pertuzumab und einem Taxan (THP). In der 2. Therapielinie (2L) löst T‑DXd, basierend auf einem hochsignifikanten Vorteil des progressionsfreien Überlebens in der DESTINY-Breast03-Studie T-DM1 ab. Bei aktiven Hirnmetastasen kann ein Tucatinib-basiertes Regime (duale Anti-HER2-Therapie aus Trastuzumab und Tucatinib plus Capecitabin) bereits in der 2L Anwendung finden, andernfalls priorisiert in der 3L. Ab der 3L stehen verschiedene Anti-HER2-Therapien zur Verfügung. Molekulare Charakteristika, die neben der Quantifizierung der HER2-Expression auch die Bestimmung weiterer Biomarker wie PD‑L1-Status und PIK3CA-Mutationen umfasst, können in Zukunft differenziertere Therapieentscheidungen ermöglichen.

Schlüsselwörter

HER2-positives Mammakarzinom - Therapiealgorithmen - zielgerichtete Therapie - therapy algorithms - targeted therapy

Publikationsverlauf

Artikel online veröffentlicht:
12. September 2023

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