Adjuvante endokrine Therapie des Mammakarzinoms in der Perimenopause

Zusammenfassung

Die adjuvante endokrine Therapie ist eine wichtige Säule der Behandlung des östrogenrezeptorpositiven Mammakarzinoms. Große Unterschiede weist die Therapie der prämenopausalen Frau gegenüber der Therapie in der Postmenopause auf. In der postmenopausalen Situation zeigen Aromataseinhibitoren (AI) gegenüber Tamoxifen zunehmend einen Vorteil. Für prämenopausale Patientinnen ist die Monotherapie mit AI aufgrund einer eventuellen paradoxen Erhöhung der Östrogensekretion kontraindiziert. In der endokrinen Therapie prämenopausaler Frauen mit primärem Mammakarzinom werden Tamoxifen und/oder die Ovarialfunktionssuppression (OFS; GnRH-Analoga, Ovarektomie) eingesetzt. Problematisch kann die Behandlung perimenopausaler Patientinnen sein. Es existieren momentan keine allgemeingültigen Therapiestrategien. Insbesondere kann die Identifizierung des tatsächlichen Menopausestatus nach bereits erfolgter Operation und Chemotherapie erschwert sein.

Abstract

Adjuvant endocrine treatment plays an important role in the treatment of estrogen responsive breast cancer. The treatment options for premenopausal women differ from those for postmenopausal women. Aromatase inhibitors (AI) improve the outcomes in postmenopausal women, while AI can induce an increase in estrogen secretion and tumor growth in premenopausal women. The standard therapy during premenopause remains tamoxifen with or without ovarian suppression by GnRH analogues. Treatment of perimenopausal breast cancer patients can be more complicated, because it is often difficult to determine menopausal status.

Schlüsselwörter

Perimenopause - Mammakarzinom - endokrine Therapie - Menopausestatus

Key words

perimenopause - breast cancer - endocrine therapy - menopausal status

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