Interdisziplinäres Konsensuspapier zum adjuvanten Einsatz von Bisphosphonaten bei Mammakarzinom-Patientinnen

Zusammenfassung

Gynäkologen und Onkologen trafen sich im November 2008, um auf der Basis der derzeit vorliegenden Evidenzen eine Empfehlung zu erarbeiten, die künftig als Grundlage für die adjuvante Therapie und Prävention des Tumorprogresses durch Bisphosphonate bei hormonrezeptorpositiven Mammakarzinom-Patientinnen dienen könnte. Maligne epitheliale Tumoren disseminieren häufig in das Knochenmark. Dieses stellt durch seinen Reichtum an Zytokinen und Wachstumsfaktoren ein ideales Kompartiment für das Überleben und Wachstum der Tumorzellen dar. In der Knochenmatrix wird eine Reihe von Wachstumsfaktoren, wie Transforming Growth Factor β (TGF-β) oder Insulin-like Growth Factor (IGF), gespeichert, die durch die osteoklastäre Resorption der Knochenmatrix freigesetzt und so für die Tumorzellen verfügbar werden. Der Knochen und das ossäre Mikromilieu spielen eine zentrale Rolle in der Tumorprogression, da disseminierte Tumorzellen im Knochenmark überdauern, Metastasen entstehen bzw. die Tumorzellen ausgehend vom Knochen wieder in die Zirkulation eintreten können, mit der Folge einer möglichen Besiedlung von weiteren distanten Organen. Verschiedene Studien haben jüngst eine Verbesserung des krankheitsfreien Überlebens beim hormonrezeptorpositivem Mammakarzinom durch die zusätzliche adjuvante Therapie mit Bisphosphonaten gezeigt. Insgesamt 12 Experten erarbeiteten unter Berücksichtigung der aktuell verfügbaren Evidenzen eine Empfehlung zum adjuvanten Einsatz der Bisphosphonate, da eine therapeutische Notwendigkeit für diese Intervention besteht, detaillierte Handlungsanweisungen zur Therapiegestaltung derzeit jedoch fehlen. Diese kritische Expertenmeinung soll basierend auf den verfügbaren Evidenzen eine adäquate Bisphosphonat-Therapie in der Adjuvanz ermöglichen.

Abstract

Gynaecologists and oncologists (listed below) met in November 2008 to draw up recommendations to be used as guidelines for adjuvant treatment with bisphosphonates for the prevention of tumour progression in receptor positive breast cancer patients based on the currently available evidence. Malignant epithelial tumours usually disseminate into bone marrow. Because of the abundance of cytokines and the stimulating growth factors found there, this microenvironment is ideal for the survival and growth of cancer cells. A variety of growth factors such as transforming growth factor β (TGF-β) or insulin-like growth factor (IGF) are accumulated within the bone matrix and can be released by stimulated osteoclasts and become available for tumour cells. Therefore the bone and its microenvironment play an important role in tumour progression because cancer cells can survive in bone marrow and grow to become bone metastases. In addition, tumour cells can reenter in the circulation and form new metastases in more distant organs. Recently, various studies have shown that adjuvant bisphosphonate therapy can improve disease-free survival in hormone receptor positive breast cancer patients. Due to medical need and because detailed guidelines for this therapeutic intervention are still lacking, twelve experts have put together recommendations for adjuvant bisphosphonate therapy based on the currently available evidence. This critical consensus could help to encourage the use of appropriate adjuvant bisphosphonate therapy in these patients.

Schlüsselwörter

Metastasen - Hormonrezeptor - disseminierte Tumorzellen

Key words

metastases - hormone receptor - tumour cells

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