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Geburtshilfe Frauenheilkd 2011; 71(4): 260-276
DOI: 10.1055/s-0030-1271020
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Review: SABCS 2010 – Aktuelle Therapie der Patientin mit einem Mammakarzinom

Review: SABCS 2010 – Current Treatment Options for Patients with Breast CancerT. Fehm1 , W. Janni2 , S. Kümmel3 , D. Lüftner4 , M. P. Lux5 , F. Schütz6 , P. A. Fasching5 , 7
  • 1Frauenklinik des Universitätsklinikums Tübingen, Tübingen
  • 2Frauenklinik des Universitätsklinikums Düsseldorf, Düsseldorf
  • 3Klinik für Senologie, Kliniken Essen-Mitte, Essen
  • 4Medizinische Klinik und Poliklinik II, Campus Charité Mitte, Berlin
  • 5Frauenklinik des Universitätsklinikums Erlangen, Erlangen
  • 6Frauenklinik des Universitätsklinikums Heidelberg, Heidelberg
  • 7University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Hematology and Oncology, Los Angeles, CA, USA
Further Information

Publication History

eingereicht 25.2.2011 revidiert 20.3.2011

akzeptiert 25.3.2011

Publication Date:
12 May 2011 (online)

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Zusammenfassung

Die Behandlungsoptionen und auch die Charakteristika zur Therapieentscheidung der Patientin mit einem primären und fortgeschrittenen Mammakarzinom werden immer vielfältiger. Neue zielgerichtete Therapien in Kombination mit etablierten Chemotherapien erweitern das Spektrum. Doch potenziell vielversprechende Kombinationen bringen nicht immer ein besseres Ergebnis. Neueste Daten aus der Pharmakogenomik weisen auf Prognose- und Prädiktivfaktoren hin, die nicht nur die Eigenschaften des Tumors, sondern auch die vererbbaren genetischen Eigenschaften der Patientin berücksichtigen. Die aktuelle Therapieentscheidung ist somit mittlerweile eine Kombination aus klassischerweise klinischen und modernen molekularen Biomarkern. Immer häufiger werden auch gesundheitsökonomische Aspekte berücksichtigt, sodass auch gesundheitspolitische Überlegungen eine Rolle spielen können. Auf dem 33. San Antonio Breast Cancer Symposium 2010 (SABCS 2010) vom 8.–12. 12. 2010 wurden zu allen Aspekten des Therapiealgorithmus bei der Patientin mit einem Mammakarzinom aktuelle Daten vorgestellt und z. T. kontrovers diskutiert. Neben Ergebnissen zur adjuvanten Therapie und zur Therapie der Patientin mit einem metastasierten Mammakarzinom stand die neoadjuvante Therapie im Vordergrund.

Abstract

The treatment options for primary and metastatic breast cancer patients and the factors considered in the decision for therapy continue to become ever more diverse. New targeted therapies in combination with established chemotherapy regimens have extended the range; however, potentially promising combinations do not always result in benefits for the patient. The latest pharmacogenomics results hint at prognostic and predictive factors which not only focus on the tumor's individual properties but also take account of the patient's hereditary genetics. As a result, state-of-the-art therapy decisions include classical clinical as well as modern molecular biomarkers; however, pharmacoeconomic aspects are also becoming increasingly important in clinical practice. The 33rd San Antonio Breast Cancer Symposium 2010 (SABCS 2010), held Dec 8–14, 2010, presented the latest data on all aspects of the breast cancer therapy algorithm with a significant role accorded to neoadjuvant therapies.

Schlüsselwörter

AZURE - TAMRAD - GeparQuinto - NeoALTTO - zirkuklierende Tumorzellen (CTC)

Key words

AZURE - TAMRAD - GeparQuinto - NeoALTTO - circulating tumorcells (CTC)

Literatur

  • 1 Rae J M, Drury S, Hayes D F et al. Lack of correlation between gene variants in Tamoxifen metabolizing enzymes with primary endpoints in the ATAC trial.  SABCS. 2010;  Abstract S1-7
    PubMedGoogle Scholar
  • 2 Leyland-Jones B, Regan M M, Bouzyk M et al. Outcome according to CYP2D6 genotype among postmenopausal women with endocrine-responsive early invasive breast cancer randomized in the BIG 1-98 trial.  SABCS. 2010;  Abstract S1-8
    PubMedGoogle Scholar
  • 3 Schroth W, Goetz M P, Hamann U et al. Association between CYP2D6 polymorphisms and outcomes among women with early stage breast cancer treated with tamoxifen.  JAMA. 2009;  302 1429-1436
    CrossrefPubMedGoogle Scholar
  • 4 Ingle J N, Liu M, Wickerham D L et al. Genome-wide associations of breast events and functional genomic studies in high-risk women receiving tamoxifen or raloxifene on NSABP P1 and P2 prevention trials. A pharmacogenomics research network-RIKEN-NSABP collaboration.  SABCS. 2010;  Abstract PD05-02
    PubMedGoogle Scholar
  • 5 Bartlett J, Brookes C, van de Velde C et al. Final results of a prospectively planned biomarker analysis: HER-1–3 as predictive markers of benefit from early treatment with aromatase inhibitors versus tamoxifen in the TEAM pathology sub-study.  Cancer Res. 2010;  70 80 s (S2-4)
    PubMedGoogle Scholar
  • 6 Dunbier A K, Ghazoui Z, Anderson H et al. Molecular profiling of aromatase inhibitor-treated postmenopausal breast tumours identifies determinants of response.  Cancer Res. 2010;  70 80 s (S2-5)
    PubMedGoogle Scholar
  • 7 Lindstroem L, Karlsson E, Wilking U et al. Discordance in hormone receptor and HER-2 status in breast cancer during tumor progression.  Cancer Res. 2010;  70 83 s (S3-5)
    PubMedGoogle Scholar
  • 8 Shulman L N, Cirrincione C, Berry D A et al. Four vs. 6 cycles of doxorubicin and cyclophosphamide (AC) or paclitaxel (T) as adjuvant therapy for breast cancer in women with 0 – 3 positive axillary nodes: CALGB 40101 – A 2×2 factorial phase III trial: first results comparing 4 vs. 6 cycles of therapy.  SABCS. 2010;  Abstract S6-3
    PubMedGoogle Scholar
  • 9 O'Shaughnessy J, Miles D, Vukelja S et al. Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer: phase III trial results.  J Clin Oncol. 2002;  20 2812-2823
    CrossrefPubMedGoogle Scholar
  • 10 Kurosumi M, Tabei T, Suemasu K et al. Enhancement of immunohistochemical reactivity for thymidine phosphorylase in breast carcinoma cells after administration of docetaxel as a neoadjuvant chemotherapy in advanced breast cancer patients.  Oncol Rep. 2000;  7 945-948
    PubMedGoogle Scholar
  • 11 Fujimoto-Ouchi K, Tanaka Y, Tominaga T. Schedule dependency of antitumor activity in combination therapy with capecitabine/5′-deoxy-5-fluorouridine and docetaxel in breast cancer models.  Clin Cancer Res. 2001;  7 1079-1086
    PubMedGoogle Scholar
  • 12 Endo M, Shinbori N, Fukase Y et al. Induction of thymidine phosphorylase expression and enhancement of efficacy of capecitabine or 5′-deoxy-5-fluorouridine by cyclophosphamide in mammary tumor models.  Int J Cancer. 1999;  83 127-134
    CrossrefPubMedGoogle Scholar
  • 13 Sawada N, Ishikawa T, Fukase Y et al. Induction of thymidine phosphorylase activity and enhancement of capecitabine efficacy by taxol/taxotere in human cancer xenografts.  Clin Cancer Res. 1998;  4 1013-1019
    PubMedGoogle Scholar
  • 14 Joensuu H, Kellokumpu-Lehtinen P-L, Huovinen R et al. FinXX final 5-year analysis: Results of the randomised, openlabel, phase II trial in medium-to-high risk early breast cancer.  SABCS. 2010;  Abstract S4-1
    PubMedGoogle Scholar
  • 15 Poole C, Barrios C, O'Shaughnessy J et al. Ongoing evaluation of capecitabine-based therapy in early breast cancer (EBC).  SABCS. 2010;  Abstract P5-10-11
    PubMedGoogle Scholar
  • 16 Joensuu H, Kellokumpu-Lehtinen P L, Huovinen R et al. Adjuvant capecitabine in combination with docetaxel and cyclophosphamide plus epirubicin for breast cancer: an open-label, randomised controlled trial.  Lancet Oncol. 2009;  10 1145-1151 Epub 2009 Nov 10
    CrossrefPubMedGoogle Scholar
  • 17 Lluch A, Gomez H, Ruiz-Borrego M et al. First safety data from a randomised phase III (CIBOMA 2004-01/GEICAM 2003-11) trial assessing adjuvant capecitabine maintenance therapy after standard chemotherapy for triple-negative early breast cancer.  SABCS. 2010;  Abstract P5-10-15
    PubMedGoogle Scholar
  • 18 O'Shaughnessy J, Devchand P, Stokoe C et al. First efficacy results of a randomized, open-label, phase II study of adjuvant doxorubicin plus cyclophosphamide followed by docetaxel with or without capecitabine in high-risk early breast cancer.  SABCS. 2010;  Abstract S4-2
    PubMedGoogle Scholar
  • 19 von Minckwitz G, Untch M, Nüesch E et al. Impact of treatment characteristics on response of different breast cancer phenotypes: pooled analysis of the German neo-adjuvant chemotherapy trials.  Breast Cancer Res Treat. 2011;  125 145-156 Epub 2010 Nov 3
    CrossrefPubMedGoogle Scholar
  • 20 Recht A, Come S E, Henderson I C et al. The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer.  N Engl J Med. 1996;  334 1356-1361
    CrossrefPubMedGoogle Scholar
  • 21 Bellon J R, Come S E, Gelman R S et al. Sequencing of chemotherapy and radiation therapy in early-stage breast cancer: updated results of a prospective randomized trial.  J Clin Oncol. 2005;  23 1934-1940
    CrossrefPubMedGoogle Scholar
  • 22 Fernando I N, Bowden S J. Buckley L at al . SECRAB: The optimal sequencing of adjuvant chemotherapy (CT) and radiotherapy (RT) in early breast cancer (EBC), results of a UK multicentre prospective randomised trial.  SABCS. 2010;  Abstract S4-4
    PubMedGoogle Scholar
  • 23 Fernando I N, Bowden S J, Buckley L et al. Acute and late toxicity results from the SECRAB trial: The optimal sequencing of adjuvant chemotherapy (CT) and radiotherapy (RT) in early breast cancer (EBC).  SABCS. 2010;  Abstract P4-11-05
    PubMedGoogle Scholar
  • 24 Coleman R E, Thorpe H C, Cameron D AZURE (BIG 01/01) Investigators et al. Adjuvant treatment with zoledronic acid in stage II/II breast cancer. The AZURE trial (BIG 01/04).  SABCS. 2010;  Abstract S4-5
    PubMedGoogle Scholar
  • 25 Sverrisdottir A, Johansson H, Johansson U et al. Interaction between goserelin and tamoxifen in a controlled clinical trial of adjuvant endocrine therapy in premenopausal breast cancer.  SABCS. 2010;  Abstract S1-5
    PubMedGoogle Scholar
  • 26 Goss P E, Ingle J N, Chapman J-A W et al. MA.27: A randomized phase II trial of exemestane versus anastrozole in postmenopausal women with hormone receptor positive primary breast cancer.  SABCS. 2010;  Abstract S1-1
    PubMedGoogle Scholar
  • 27 Gianni L, Pienkowski T, Im Y-H et al. Neoadjuvant pertuzumab (P) and trastuzumab (H): antitumor and safety analysis of a randomized phase II study (‘NeoSphere ).  Cancer Res. 2010;  70 (24 Suppl.) 82s
    CrossrefPubMedGoogle Scholar
  • 28 Baselga J, Bradbury I, Eidtmann H et al. First results of the NeoALTTO trial (BIG 01-06/EGF 106903): a phase III, randomized, open label, neoadjuvant study of lapatinib, trastuzumab, and their combination plus paclitaxel in women with HER-2-positive primary breast cancer.  Cancer Res. 2010;  70 (24 Suppl.) 82s
    CrossrefPubMedGoogle Scholar
  • 29 Untch M, Loibl S, Bischoff J et al. Lapatinib vs. trastuzumab in combination with neoadjuvant anthracycline-taxane-based chemotherapy: primary efficacy endpoint analysis of the GEPARQUINTO STUDY (GBG 44).  SABCS. 2010;  Abstract S3-1
    PubMedGoogle Scholar
  • 30 Bischoff J, Ignatov A. The role of targeted agents in the treatment of metastatic breast cancer.  Breast Care (Basel). 2010;  5 134-141 Epub 2010 Jun 16
    CrossrefPubMedGoogle Scholar
  • 31 von Minckwitz G, Eidtmann H, Rezai M et al. Neoadjuvant chemotherapy with or without Bevacizumab: Primary efficacy endpoint analysis of the GEPARQUINTO Study (GBG 44).  SABCS. 2010;  Abstract S4-6
    PubMedGoogle Scholar
  • 32 Loibl S, Amant F, Kaufmann M et al. 313 patients with breast cancer during pregnancy – results from a prospective and retrospective registry (GBG-20/BIG 02-03).  SABCS. 2010;  Abstract S6-2
    PubMedGoogle Scholar
  • 33 Bachelot T, Bourgier C, Cropet C et al. TAMRAD: a GINECO randomized phase II trial of everolimus in combination with tamoxifen versus tamoxifen alone in patients (pts) with hormone-receptor positive, HER-2 negative metastatic breast cancer (MBC) with prior exposure to aromatase inhibitors (AI).  SABCS. 2010;  Abstract S1-6
    PubMedGoogle Scholar
  • 34 Kaufman P A, Ferrero J M, Bourgeois H et al. A randomized, placebo-controlled, phase 2 study of AMG 479 with exemestane (E) or fulvestrant (F) in postmenopausal women with hormone-receptor positive (HR+) locally advanced (LA) or metastatic (M) breast cancer (BC).  SABCS. 2010;  Abstract S1-4
    PubMedGoogle Scholar
  • 35 Di Leo A, Jerusalem G, Petruzelka L et al. Results of the CONFIRM phase III trial comparing fulvestrant 250 mg with fulvestrant 500 mg in postmenopausal women with estrogen receptor-positive advanced breast cancer.  J Clin Oncol. 2010;  28 4594-4600
    CrossrefPubMedGoogle Scholar
  • 36 Robertson J F R, Lindemann J P O, Llombart-Cussac A et al. A comparison of fulvestrant 500 mg with anastrozole as first-line treatment for advanced breast cancer: follow-up analysis from the ‘FIRST’ study.  SABCS. 2010;  Abstract S1-3
    PubMedGoogle Scholar
  • 37 Rack B K, Schindlbeck C, Andergassen U et al. Use of circulating tumor cells (CTC) in peripheral blood of breast cancer patients before and after adjuvant chemotherapy to predict risk for relapse: The SUCCESS trial.  J Clin Oncol. 2010;  28 15s (Suppl., Abstr. 1003)
    PubMedGoogle Scholar
  • 38 Giordano A, Giuliano M, Hsu L et al. Prognostic value of circulating tumor cells (CTC) in metastatic breast cancer (MBC): correlation with immunohistochemically defined molecular subtypes and metastatic disease sites.  J Clin Oncol. 2010;  28 15s (Suppl., Abstr. 1000)
    PubMedGoogle Scholar
  • 39 Pierga J-Y, Bachelot T, Delaloge S et al. High independent prognostic and predictive value of circulating tumor cells in a large prospective multicenter trial including serum tumor markers in first line chemotherapy metastatic breast patients.  SABCS. 2010;  Abstract S6-6
    PubMedGoogle Scholar
  • 40 Aktas B, Tewes M, Kimmig R et al. Molecular profiling of circulating tumor cells in blood of metastatic breast cancer patients indicates therapy response and provides information on epithelial mesenchymal transition and tumor stem cell metabolism.  SABCS. 2010;  Abstract PD04-04
    PubMedGoogle Scholar
  • 41 Rack B, Schindlbeck C, Andergassen U et al. Prognostic relevance of circulating tumor cells in the peripheral blood of primary breast cancer patients.  SABCS. 2010;  Abstract S6-5
    PubMedGoogle Scholar
  • 42 Pierga J-Y, Bidard F-C, Petit T et al. Monitoring circulating tumor cells (CTC) and circulating endothelial cells (CEC) during neoadjuvant combination of trastuzumab and bevacizumab with chemotherapy in HER-2 overexpressing inflammatory breast cancer (IBC): an ancillary study of BEVERLY 2 multicenter phase II trial.  SABCS. 2010;  Abstract PD04-07
    PubMedGoogle Scholar
  • 43 Riethdorf S, Mueller V, Mauermann O et al. Changes in circulating tumor and endothelial cells in peripheral blood of patients treated in the neoadjuvant chemotherapy plus targeted treatment breast cancer study “GeparQuinto”.  SABCS. 2010;  Abstract PD04-06
    PubMedGoogle Scholar
  • 44 Spector N. Duke University Medical Center Durham, NC .Drug development – targeting HER-2 beyond trastuzumab. Plenary lecture. SABCS 2010. 
    Google Scholar
  • 45 Blackwell K L, Burstein H J, Storniolo A M et al. Randomized study of lapatinib alone or in combination with trastuzumab in women with ErbB2-positive, trastuzumab-refractory metastatic breast cancer.  J Clin Oncol. 2010;  28 1124-1130
    CrossrefPubMedGoogle Scholar
  • 46 Carey L A. University of North Carolina Chapel Hill, NC .Progress in advanced breast cancer. The year in review. SABCS 2010. 
    Google Scholar
  • 47 Bernow M, Wilking U, Bergh J et al. Re-testing of HER-2 status in recurring metastatic breast cancer is a clinically relevant and cost-effective strategy.  Cancer Res. 2010;  70 (24 Suppl.) 157s-158s
    CrossrefPubMedGoogle Scholar
  • 48 Sledge jr. G W. Indiana University Simon Cancer Center Indianapolis, IN .What would Bill do? Channeling your inner McGuire. William McGuire memorial lecture. SABCS 2010. 
    Google Scholar
  • 49 Hershman D L, Neugut A I, Subar M et al. Association between prescription co-payment amount and compliance with adjuvant aromatase inhibitor therapy in women with early stage breast cancer.  Cancer Res. 2010;  70 (24 Suppl.) 91s
    CrossrefPubMedGoogle Scholar
  • 50 Sehgal R, Lark C. A pharmaco-economic analysis of tamoxifen (T) vs. aromatase inhibitors (AI) in adjuvant treatment of postmenopausal (PoM) women (W) with hormone receptor positive (HRP) breast cancer (BC).  Cancer Res. 2010;  70 (24 Suppl.) 157s
    CrossrefPubMedGoogle Scholar
  • 51 Hershman D L, Shao T, Kushi L H et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer.  Breast Cancer Res Treat. 2011;  126 529-537
    CrossrefPubMedGoogle Scholar
  • 52 Force R W, Pugmire B A, Culbertson V L. Taxanes in metastatic breast cancer: claims analysis of neutropenia, infections, and CSF costs.  Cancer Res. 2010;  70 (24 Suppl.) 157s
    CrossrefPubMedGoogle Scholar
  • 53 Arpino G, Cammarota S, Ianniello G et al. Imaging tests in staging and surveillance of early breast cancer (EBC) – changes in routine clinical practice and cost implications.  Cancer Res. 2010;  70 (24 Suppl.) 158s
    CrossrefPubMedGoogle Scholar
  • 54 Chastek B, Gao S, O'Malley C et al. Health care costs incurred by post-menopausal women with hormone-positive breast cancer following the initial diagnosis of metastasis.  Cancer Res. 2010;  70 (24 Suppl.) 156s
    CrossrefPubMedGoogle Scholar
  • 55 Baser O, Wei W, Henk H J et al. Survival, health care cost and utilization of patients with triple negative breast cancer in a U.S. managed care setting.  Cancer Res. 2010;  70 (24 Suppl.) 158s-159s
    CrossrefPubMedGoogle Scholar

Tanja Fehm

Universitäts-Frauenklinik Tübingen

Calwer Straße 7

72076 Tübingen

Email: tanja.fehm@med.uni-tuebingen.de

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