Systemische Therapie von prämenopausalen Patientinnen mit hormonrezeptorpositivem, HER2-negativem Brustkrebs in den Frühstadien – Kontroversen und Standards in der Krankenversorgung

Volkmar Müller; Peter A. Fasching; Naiba Nabieva; Tanja N. Fehm; Marc Thill; Marcus Schmidt; Thorsten Kühn; Maggie Banys-Paluchowski; Erik Belleville; Ingolf Juhasz-Böss; Michael Untch; Hans-Christian Kolberg; Nadia Harbeck; Bahriye Aktas; Elmar Stickeler; Julia Kreuzeder; Andreas D. Hartkopf; Wolfgang Janni; Nina Ditsch

doi:10.1055/a-2238-9693

Senologie - Zeitschrift für Mammadiagnostik und -therapie, Table of Contents

Senologie - Zeitschrift für Mammadiagnostik und -therapie 2024; 21(01): 61-74
DOI: 10.1055/a-2238-9693

Übersicht

Systemische Therapie von prämenopausalen Patientinnen mit hormonrezeptorpositivem, HER2-negativem Brustkrebs in den Frühstadien – Kontroversen und Standards in der Krankenversorgung

Systemic Therapy of Premenopausal Patients with Early Stage Hormone Receptor-Positive, HER2-Negative Breast Cancer – Controversies and Standards in Healthcare

Authors

Volkmar Müller

¹Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
Peter A. Fasching

²Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Naiba Nabieva

³Novartis Pharma GmbH, Nürnberg, Germany
Tanja N. Fehm

⁴Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
Marc Thill

⁵Department of Gynecology and Gynecological Oncology, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
Marcus Schmidt

⁶Universitäts-Frauenklinik Mainz, Mainz, Germany
Thorsten Kühn

⁷Filder-Klinik, Filderstadt-Bonlanden, Germany
Maggie Banys-Paluchowski

⁸Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
Erik Belleville

⁹ClinSol GmbH & Co KG, Würzburg, Germany
Ingolf Juhasz-Böss

¹⁰Universitäts-Frauenklinik Freiburg, Freiburg, Germany (Ringgold ID: RIN14879)
Michael Untch

¹¹Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany (Ringgold ID: RIN62473)
Hans-Christian Kolberg

¹²Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
Nadia Harbeck

¹³Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, München, Germany
Bahriye Aktas

¹⁴Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
Elmar Stickeler

¹⁵Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany
Julia Kreuzeder

³Novartis Pharma GmbH, Nürnberg, Germany
Andreas D. Hartkopf

¹⁶Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany (Ringgold ID: RIN27197)
Wolfgang Janni

¹⁶Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany (Ringgold ID: RIN27197)
Nina Ditsch

¹⁷Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)

Abstract

Zusammenfassung

Die adjuvante endokrine Behandlung von prämenopausalen Patientinnen mit einem hormonrezeptorpositiven, HER2-negativen (HR-pos./HER2-neg.) Mammakarzinom unterliegt bei bestehender Ovarialfunktion einigen Besonderheiten. Als therapeutische Optionen stehen Tamoxifen mit oder ohne GnRH-Analogon und Aromatasehemmer mit GnRH-Analogon zur Verfügung. Des Weiteren wird die Ovarialfunktion durch eine vorherige Chemotherapie beeinflusst. Sowohl die Indikation für GnRH-Analoga in Kombination mit Tamoxifen als auch die Indikation für Aromatasehemmer (+GnRH-Analoga) sind für Patientinnen mit einem erhöhten Rückfallrisiko vorgesehen.

In nationalen und internationalen Leitlinien und Therapieempfehlungen ist jedoch keine klare Grenze für ein mittleres oder hohes Risiko definiert, sodass viele Therapieentscheidungen für jede Patientin individuell getroffen werden. Dies spiegelt sich auch in einer großen nationalen und internationalen Variabilität z. B. beim Einsatz von Aromatasehemmern + GnRH-Analoga wider.

Diese Übersichtsarbeit fasst die Datenlage zu den abgeschlossenen Studien (z. B. SOFT, TEXT, EBCTCG-Metaanalysen), den aktuellen Multigentest-Studien (TailorX, RxPonder, ADAPT) zusammen, diskutiert die Rationale für aktuell durchgeführte Studien (z. B. CLEAR-B) und gibt einen Ausblick auf künftige Fragestellungen.

Abstract

In patients with existing ovarian function, there are some special aspects to adjuvant endocrine therapy in premenopausal patients with hormone receptor-positive, HER2-negative (HR pos./HER2 neg.) breast cancer. Treatment options include tamoxifen with or without a GnRH analog, and aromatase inhibitors with a GnRH analog. Furthermore, ovarian function is affected by previous chemotherapy. Both aromatase inhibitors (+GnRH analogs) and GnRH analogs in combination with tamoxifen are supposed to be indicated for patients at increased risk of recurrence.

However, national and international guidelines and therapy recommendations do not provide a clear definition of intermediate or high risk; as a result, therapy decisions are often made for each patient on an individual basis. This is also reflected in the considerable variability at national and international levels, e.g., with regard to the use of aromatase inhibitors + GnRH analogs.

This review summarizes the data on completed studies (e.g., SOFT, TEXT, EBCTCG meta-analyses) and the current multigene testing studies (TailorX, RxPonder, ADAPT), discusses the rationale for current studies (e.g., CLEAR-B), and looks ahead to future questions.

Schlüsselwörter

Brustkrebs - prämenopausale Therapie - Aromatasehemmer - Tamoxifen - GnRH

Keywords

breast cancer - premenopausal therapy - aromatase inhibitor - tamoxifen - GnRH

Full Text

References

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