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Frauenheilkunde up2date 2013; 7(5): 363-373
DOI: 10.1055/s-0033-1346688
Allgemeine Gynäkologie und gynäkologische Onkologie
Georg Thieme Verlag KG Stuttgart · New York

Zielgerichtete Therapien in der Behandlung des Mammakarzinoms

Jörg B. Engel
,
Olaf Ortmann
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Publication Date:
16 October 2013 (online)

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Kernaussagen

HER2/neu überexprimierendes Mammakarzinom

Die Dauer der adjuvanten Therapie mit Trastuzumab bleibt weiterhin 12 Monate (PHARE-Studie, HERA-Studie). In der Erstlinientherapie des HER2/neu-positiven, metastasierten Mammakarzinoms führt die Kombinationstherapie mit Trastuzumab und Pertuzumab zu einer signifikanten Verlängerung des progressionsfreien Überlebens und wahrscheinlich des Gesamtüberlebens (CLEOPATRA-Studie). Pertuzumab ist für diese Indikation zugelassen. In der Zweitlinientherapie des HER2/neu überexprimierenden Mammakarzinoms nach Versagen einer Trastuzumabtherapie verbesserte das zytotoxische Hybridmolekül TDM1 das PFS und das OAS signifikant. Für Deutschland wird eine Zulassung Ende 2013 erwartet.

Hormonrezeptor-positives Mammakarzinom

In der adjuvanten Situation führt eine 10-jährige Tamoxifentherapie im Vergleich zu einer 5-jährigen Tamoxifentherapie zu einem signifikanten Überlebensvorteil. Die brustkrebsbedingte Mortalität wird um 12 % gesenkt. Im metastasierten, Hormonrezeptor-positiven Mammakarzinom nach Versagen eines nicht steroidalen Aromatase-Inhibitors führt der mTOR-Inhibitor Everolimus in Kombination mit Exemestan zu einer signifikanten Verbesserung des progressionsfreien Überlebens bei insgesamt moderaten Nebenwirkungen. Deswegen wurde dieser Kombinationstherapie ab Herbst 2012 bei postmenopausalen Patientinnen nach Versagen eines nicht steroidalen Aromatasehemmers die Zulassung erteilt.

Triple-negatives Mammakarzinom

Bevacizumab führt in der metastasierten Situation zu einer Verbesserung des progressionsfreien Überlebens, ohne das Gesamtüberleben zu beeinflussen (E2100, AVADO Ribbon-1). In der neoadjuvanten Situation führt die Hinzunahme von Bevacizumab zu einer anthrazyklin- und taxanhaltigen Chemotherapie zu keiner Verbesserung der Rate der pathologischen Komplettremission (Gepar-Quinto-Studie, NSABP-B-40-Studie).

 

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