Mammakarzinom – Adjuvante und neoadjuvante Chemo- und Antikörpertherapie

Beim nicht-metastasierten Mammakarzinom ist die konsequente adjuvante systemische Therapie der wesentliche Grund für die substantielle Verbesserung der Prognose. Die Indikation ergibt sich aus dem Rückfallrisiko und der Prädiktion des Therapieeffektes. Prognostische und prädiktive Informationen ergeben sich vor allem aus Östrogenrezeptorstatus (ER), HER2-Expression und Proliferationsrate. Bei der Chemotherapie kommen Anthrazykline, Taxane und Cyclophosphamid zum Einsatz. Dosisdichte Therapien mit verkürzten Therapieintervallen – durch primäre Gabe von G-CSF ermöglicht – haben eine höhere Effektivität bei ähnlicher Toxizität und werden heute vielfach bevorzugt. Die Therapie mit dem anti HER2-Antikörper Trastuzumab über ein Jahr ist Standard bei HER2-positiver Erkrankung. ER-positive Patientinnen erhalten – unabhängig von der Chemotherapie – immer eine endokrine Therapie. Neoadjuvante Therapien ermöglichen eine Therapieanpassung und können die brusterhaltende Therapie erleichtern. Sie sind bei HER2-positiven und bei ER-negativen Karzinomen zu bevorzugen, da bei diesen Tumoren die Tumorremission mit dem rückfallfreien Überleben korreliert. Indikation und Art der (neo)adjuvanten systemischen Therapie werden individuell festgelegt.

In cases of non-metastasizing breast cancer a consequent adjuvant systemic therapy is one of the main reasons for the substantial improvements in prognosis. The indication arises from the recurrence risk and the prediction of a therapeutic effect. Prognostic and predictive information is provided above all by the estrogen receptor status (ER), HER2 expression and proliferation rate. For chemotherapy anthracyclines, taxanes and cyclophosphamide are available for use. Densely dosed therapies with shortened therapy intervals made possible by the primary administration of G-CSF, exhibit a higher efficacy with comparable toxicity and are thus preferred in many cases. Therapy with the anti-HER2 antibody trastuzumab for one year is now the standard for HER2-positive disease. ER-positive patients, irrespective of their chemotherapy, should always receive an endocrine therapy. Neoadjuvant therapies pave the way for therapy adaptations and can facilitate breast-preserving therapies. They are to be preferred for HER2-positive and ER-negative cancers, since tumor remission correlates with relapse-free survival for these tumor types. The indication for and type of (neo)adjuvant systemic therapy is selected on an individual basis.

Key words

Breast cancer - types - chemotherapy - antibody therapy - neoadjuvant - adjuvant

• Literatur

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