Erstbehandlung von Patientinnen mit primärem Mammakarzinom: Evidenz, Kontroversen, Konsens

Zusammenfassung

Seit über 30 Jahren findet regelmäßig (in den letzten 6 Jahren alle 2 Jahre) die internationale St. Gallen-Konsensuskonferenz zur Behandlung von Patientinnen mit primärem Mammakarzinom statt. Die Ergebnisse des internationalen St. Gallen-Konsensus-Panels wurden auch dieses Jahr wieder von einer deutschen Arbeitsgruppe führender Brustkrebsexperten für den Klinikalltag in Deutschland diskutiert. Fünf der Brustkrebsexperten aus Deutschland sind zugleich Mitglieder des diesjährigen St. Gallen-Panels. Der Vergleich der St. Gallen-Empfehlungen mit den jährlich aktualisierten Therapieempfehlungen der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO-Mamma 2017) und der aktuell im Jahre 2017 abgestimmten S3-Leitlinie ist sinnvoll. Die Empfehlungen des St. Gallen-Panels stellen ein Meinungsbild von Experten unterschiedlicher Länder und Fachdisziplinen dar, wohingegen S3-Leitlinie und AGO-Empfehlungen evidenzbasiert sind. Die diesjährige 15. St. Gallen-Konsensuskonferenz stand unter dem Motto „Escalating and De-Escalating“, das sich durch alle Therapiebereiche zog, die zur Abstimmung standen. Ziel war es, Patientinnen individuellere Therapieoptionen anzubieten und das Risiko einer Über- bzw. Untertherapie zu vermeiden.

Schlüsselwörter

St. Gallen-Konsensus 2017 - frühes Mammakarzinom - systemische Therapie - lokale Therapie - Multigenexpression - Pathologie - Schwangerschaft - Brustkrebs beim Mann

^* St. Gallen Panel Expert

• References/Literatur

• 1 Diagnosis and treatment of patients with primary and metastatic breast cancer (Version 2017 1D). Online: http://www.ago-online.de last access: 23.03.2017
• 2 Jagsi R, Chadha M, Moni J. et al. Radiation field design in the ACOSOG Z0011 (Alliance) Trial. J Clin Oncol 2014; 32: 3600-3606
• 3 Kuehn T, Bauerfeind I, Fehm T. et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 2013; 14: 609-618
• 4 Online: http://www.astro.org last access: 24.04.2017
• 5 Online: http://www.estro.org last access: 24.04.2017
• 6 Smith BD, Arthur DW, Buchholz TA. et al. Consensus Statement der ASTRO. Int J Rad Oncol Bio Phys 2009; 74: 987-1001
• 7 Polgàr C, Van Limbergen E, Pötter R. et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 2010; 94: 264-273
• 8 Donker M, van Tienhoven G, Straver ME. et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 2014; 15: 1303-1310
• 9 Buus R, Sestak I, Kronenwett R. et al. Comparison of EndoPredict and EPclin with Oncotype DX Recurrence Score for prediction of risk of distant recurrence after endocrine therapy. J Natl Cancer Inst 2016; 108: djw149
• 10 Sestak I, Buus R, Cuzick J. et al. Comprehensive comparison of prognostic signatures for breast cancer recurrence in TransATAC. SABCS 2016, S6-05.
• 11 Francis PA, Regan MM, Fleming GF. et al. Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med 2015; 372: 436-446
• 12 Pagani O, Regan MM. Francis PA; TEXT and SOFT Investigators, International Breast Cancer Study Group. Exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med 2014; 371: 1358-1359
• 13 Cuzick J, Sestak J, Baum M. et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10 year analysis of the ATAC trial. Lancet Oncol 2010; 11: 1135-1141
• 14 Regan MM, Neven P, Giobbie-Hurder A. et al. Assessment of letrozole and tamoxifen alone and in sequence for postmenopausal women with steroid hormone receptor-positive breast cancer: the BIG 1-98 randomised clinical trial at 8.1 years median follow-up. Lancet Oncol 2011; 12: 1101-1108
• 15 Sparano JA, Gray RJ, Makower DF. et al. Prospective validation of 21-gene expression assay in breast cancer. N Engl J Med 2015; 373: 2005-2014
• 16 Nitz U. Prospective WSG Phase III PlanB trial: Clinical outcome at 5-year follow up and impact of 21 Gene Recurrence Score result, central/local-pathological review of grade, ER, PR and Ki67 in HR+/HER2- high risk node-negative and -positive breast cancer. Vortrag ESMO/ECCO-Jahrestagung 2016, LBA 8.
• 17 Gluz O, Nitz UA, Christgen M. et al. West German Study Group Phase III Plan B Trial: first prospective outcome data for the 21-gene recurrence score assay and concordance of prognostic markers by central and local pathology assessment. J Clin Oncol 2016; 24: 2341-2349
• 18 Cardoso F, vanʼt Veer LJ, Bogaerts J. et al. 70-Gene signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med 2016; 375: 717-729
• 19 Vaz-Luis I, Ottesen RA, Hughes ME. et al. Outcomes by tumor subtype and treatment pattern in women with small, node-negative breast cancer: a multi-institutional study. J Clin Oncol 2014; 32: 2142-2150
• 20 Ignatov T, Eggemann H, Burger E. et al. Management of small T1a/b breast cancer by tumor subtype. Breast Cancer Res Treat 2017; 163: 111-118
• 21 Kolben T, Harbeck N, Wuerstlein R. et al. Endocrine sensitivity is decisive for patient outcome in small node-negative breast cancers (BC) (pT1a,b) – results from the Munich Cancer Registry. Breast 2014; 24: 24-31
• 22 National Comprehensive Cancer Network. Online: http://www.nccn.org last access: 24.04.2017
• 23 von Minckwitz G, Schneeweiss A, Loibl S. et al. Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial. Lancet Oncol 2014; 15: 747-756
• 24 Wolff AC, Hammond ME, Hicks DG. et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guidelines update. J Clin Oncol 2013; 31: 3997-4013
• 25 Slamon DJ, Eiermann W, Robert NJ. et al. Ten-year follow-up of BCIRG-006 comparing doxorubicin plus cyclophosphamide followed by docetaxel with doxorubicin plus cyclophosphamide followed by docetaxel and trastuzumab with docetaxel, carboplatin and trastuzumab in HER2-positive early breast cancer patients. SABCS 2015, S5-04.
• 26 Von Minckwitz G, Procter MJ, De Azambuja E. et al. Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer. N Engl J Med 2017;
• 27 Pivot XB, Bondarenko I, Dvorkin M. et al. A randomized, double-blind, phase III study comparing SB3 with originator trastuzumab in patients treated by neoadjuvant therapy for HER2-positive early breast cancer. ASCO 2017, Poster 509.
• 28 Stebbing J, Baranau YV, Baryash V. et al. Double-blind, randomized phase III study to compare the efficacy and safety of CT-P6, trastuzumab biosimilar candidate versus trastuzumab as neoadjuvant treatment in HER2 positive early breast cancer. ASCO 2017, Poster 510.
• 29 Untch M, Jackisch C, Schneeweiss A. et al. Nab-paclitaxel versus solvent-based paclitaxel in neoadjuvant chemotherapy for early breast cancer (GeparSepto-GBG 69): a randomised, phase 3 trial. Lancet Oncol 2016; 17: 345-356
• 30 Masuda N, Lee SJ, Ohtani S. et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med 2017; 376: 2147-2159
• 31 Nangia J, Wang T, Niravath P. et al. Scalp Cooling Alopecia Prevention Trial. SABCS 2016, S5-02.
• 32 Early Breast Cancer Trialistsʼ Collaborative Group (EBCTCG). Coleman R, Powles T. et al. Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet 2015; 386: 1353-1361
• 33 Gnant M, Mlineritsch B, Stoeger H. et al. Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 62-month follow-up from the ABCSG-12 randomised trial. Lancet Oncol 2011; 12: 631-641