Chemoendokrine Therapie des Mammakarzinoms bei prämenopausalen Patientinnen

Zusammenfassung

Im Rahmen der adjuvanten endokrinen Therapie des prämenopausalen Mammakarzinoms besitzt die ovarielle Ablation eine besondere Bedeutung. Die Wirksamkeit dieser Therapieform wurde in etlichen Studien belegt, zu denen mittlerweile auch Langzeitergebnisse vorliegen. Derzeit verfügbare endokrine Therapien senken entweder die Östrogenproduktion oder modulieren die Aktivität des Östrogenrezeptors (ER) bzw. regulieren die Expression des ER. Die Wirksamkeit von Chemotherapien bei prämenopausalen Patientinnen wird unter anderem auf die Induktion einer sekundären Amenorrhö zurückgeführt. Der Vergleich von Standardchemotherapien mit endokrinen Therapieformen zeigt, dass die ovarielle Suppression bei prämenopausalen Patientinnen mit hormonsensiblem Mammakarzinom einer Chemotherapie gleichwertig ist. Die ovarielle Ablation verbessert das Langzeitüberleben von Patientinnen unter 50 Jahren, zumindest in Abwesenheit einer Chemotherapie. Bei prämenopausalen Patientinnen mit hormonsensiblem Mammakarzinom scheint die ovarielle Suppression mit Goserelin mit oder ohne Tamoxifen äquieffektiv zu sein zur Chemotherapie mit CMF. Es gibt Hinweise, dass Goserelin plus Tamoxifen effektiver ist als eine Goserelin-Monotherapie, zumindest wenn auch eine Chemotherapie durchgeführt wurde. Der sequenzielle Einsatz von Goserelin nach CMF scheint besser als die jeweilige Monotherapie bei Patientinnen mit nodalnegativem Mammakarzinom; dies gilt zumindest für Patientinnen unter 40 Jahren mit hormonsensiblem Tumor. Die alleinige Chemotherapie bei Patientinnen unter 35 Jahren mit hormonsensiblem Mammakarzinom ist nicht ausreichend. Eine eindeutige Aussage zum kombinierten Einsatz von Chemotherapie und endokriner Therapie kann zum jetzigen Zeitpunkt jedoch aufgrund der angeführten Datenlage abschließend nicht gegeben werden (Tab. [1]).

Abstract

Ovarian ablation has been used for a long period of time as an effective method in breast cancer treatment. The effectiveness of this therapy has been proven by multiple trials which by now provide long-time results. Currently available endocrine therapies either lower estrogen production or modulate estrogen receptor (ER) activity or regulate the expression of the ER. The efficacy of chemotherapy is partly related to the induction of secondary amenorrhea in premenopausal women by cytotoxic agents. A comparison of current standard chemotherapies with endocrine therapies shows that ovarian suppression and chemotherapy are equieffective in premenopausal women with hormone-sensitive breast cancer. Ovarian ablation increases long-lasting survival in breast cancer patients younger than 50 years of age, at least in the absence of chemotherapy. In premenopausal women with hormone-sensitive breast cancer ovarian suppression with gosereline with or without tamoxifen seems to be at least as effective as CMF chemotherapy alone. There are data which indicate a superiority of gosereline plus tamoxifen to gosereline monotherapy, at least if chemotherapy has been applied as well. Sequential use of gosereline after CMF chemotherapy seems to be superior to any modality alone in node-negative patients, at least in women younger than 40 years of age with hormone-sensitive tumors. Monochemotherapy alone is not sufficient in patients younger than 35 years of age with hormone-sensitive tumors. On the basis of the available data a final answer to the use of combined chemoendocrine therapy cannot be given as yet.

Schlüsselwörter

Mammakarzinom - Prämenopause - chemoendokrine Therapie - GnRH-Analoga - ovarielle Suppression

Key words

Breast cancer - premenopause - chemoendocrine therapy - GnRH-analogues - ovarian function suppression

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