Genexpressionsanalysen beim frühen Mammakarzinom – quo vadis?

Zusammenfassung

Zur Festlegung der adjuvanten Therapie beim Mammakarzinom ist eine möglichst genaue Einschätzung des Risikos für einen Rückfall von entscheidender Bedeutung. In diesem Zusammenhang sind die Genexpression und damit auch Genexpressionssignaturen als Prognosefaktoren in den Mittelpunkt des Interesses gerückt. Für den praktischen Einsatz ist es wichtig, dass Genexpressionssignaturen an formalinfixiertem, paraffineingebettetem Tumorgewebe durchgeführt werden können. Um eine ungenaue Risikoklassifikation und damit eine mögliche Unter- oder Übertherapie der Patientinnen zu vermeiden, müssen sorgfältige analytische und klinische Validierungen und ein hoher Level of Evidence (LoE) gefordert werden. Von den kommerziell erhältlichen Genexpressionssignaturen werden derzeit MammaPrint^® und Oncotype DX^® mit prospektiven Studienergebnissen als LoE IA sowie Endopredict^® und Prosigna^® als LoE IB von der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) eingestuft. Ebenso votierten die Panelmitglieder der diesjährigen St. Gallen Konsensuskonferenz mehrheitlich für den möglichen Einsatz von Oncotype DX^®, MammaPrint^®, Prosigna^®, EndoPredict^® und Breast Cancer Index^®. Diese Multigentests können bei ausgewählten hormonrezeptorpositiven und HER2-negativen Patientinnen eingesetzt werden, wenn alle anderen Kriterien keine Therapieentscheidung zulassen.

Schlüsselwörter

Genexpression - Mammakarzinom - intrinsische Subtypen - Prognose - Evidenz

Key words

gene expression - breast carcinoma - intrinsic subtypes - prognosis - evidence

• References

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