Update Mammakarzinom 2019 Teil 3 – aktuelle Entwicklungen bei der kurativen Behandlung von Mammakarzinompatientinnen: eine Übersicht und Bewertung durch ein internationales Expertenpanel

Zusammenfassung

Die Behandlung von Mammakarzinompatientinnen in der kurativen Situation ist in vielfacher Hinsicht besonders. Die lokale Therapie mit Operation und Strahlentherapie ist zentraler Aspekt der Behandlung. Ziel ist eine komplette Elimination aller Tumorzellen am Ort der Primärerkrankung bei gleichzeitigem Bestreben, die Langzeitfolgen so gering wie möglich zu halten. Die immer weitere Reduktion der Radikalität der Lokaltherapie steht auch weiterhin im Blickpunkt. In Bezug auf die Systemtherapie haben sich in den letzten beiden Jahrzehnten Chemotherapien mit Taxanen, Anthrazyklinen und teilweise auch platinhaltigen Chemotherapien etabliert. Der Kontext der Nutzung wird immer genauer definiert. Ebenso gibt es bei der antihormonellen Therapie Fragen, die auch nach Einführung der Aromatasehemmer immer noch weiter definiert werden müssen, wie beispielsweise die Länge der Therapie oder die ovarielle Suppression bei prämenopausalen Patientinnen. Letztlich soll die Behandlung von frühen Mammakarzinompatientinnen immer personalisierter werden. Prognostische Genexpressionstests könnten möglicherweise Therapieentscheidungen unterstützen. Ebenso muss überlegt werden, wie ein möglicher Einsatz von neuen Therapien wie Checkpointinhibitoren und CDK4/6-Inhibitoren in der Praxis aussehen könnte, sobald dazu Studienergebnisse vorliegen. Diese Übersichtsarbeit beschäftigt sich mit den Hintergründen zu aktuellen Abstimmungen, die das internationale St.‑Gallen-Expertenpanel in Wien 2019 für aktuelle Fragen in der Behandlung von Mammakarzinompatientinnen in der kurativen Situation vorgenommen hat.

Abstract

The treatment of breast cancer patients in a curative situation is special in many ways. The local therapy with surgery and radiation therapy is a central aspect of the treatment. The complete elimination of tumour cells at the site of the primary disease must be ensured while simultaneously striving to keep the long-term effects as minor as possible. There is still focus on the continued reduction of the invasiveness of local therapy. With regard to systemic therapy, chemotherapies with taxanes, anthracyclines and, in some cases, platinum-based chemotherapies have become established in the past couple of decades. The context for use is being continually further defined. Likewise, there are questions in the case of antihormonal therapy which also still need to be further defined following the introduction of aromatase inhibitors, such as the length of therapy or ovarian suppression in premenopausal patients. Finally, personalisation of the treatment of early breast cancer patients is also being increasingly used. Prognostic tests could potentially support therapeutic decisions. It must also be considered how the possible use of new therapies, such as checkpoint inhibitors and CDK4/6 inhibitors could look in practice once study results in this regard are available. This overview addresses the backgrounds on the current votes taken by the international St. Gallen panel of experts in Vienna in 2019 for current questions in the treatment of breast cancer patients in a curative situation.

Schlüsselwörter

frühes Mammakarzinom - adjuvante Therapie - neoadjuvante Therapie - St.‑Gallen‑Expertenpanel

Key words

early breast cancer - adjuvant therapy - neoadjuvant therapy - St. Gallen panel of experts

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