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Zentralbl Gynakol 2003; 125(9): 315-321
DOI: 10.1055/s-2003-43044
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Die adjuvante Hormontherapie des Mammakarzinoms nach St. Gallen 2003

Adjuvant Endocrine Treatment of Breast Cancer beyond St. Gallen 2003B. Gerber1
  • 1I. Frauenklinik (Direktor: Prof. Dr. K. Friese) der LMU München
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Publication History

Publication Date:
21 October 2003 (online)

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Zusammenfassung

Die aktuellen Therapieempfehlungen (8th International Conference on Primary Therapy of Early Breast Cancer, March 12-15, 2003 St. Gallen/Switzerland) bestätigen zum einen etablierte Therapien und lassen gleichzeitig neue endokrine Therapien zu. So stellt der zeitlich begrenzte Hormonentzug (2 Jahre Goserelin + 5 Jahre Tamoxifen) eine effektive Therapieoption bei prämenopausalen Patientinnen mit einem hormonsensitiven Mammakarzinom dar und ist einer CMF-Chemotherapie gleichwertig. Bei „sehr” jungen Frauen ist die adjuvante Chemotherapie allein nicht ausreichend, sondern sollte durch eine endokrine Therapie ergänzt werden. Ein wesentlicher Vorteil der endokrinen Therapie ist der nur zeitlich begrenzte Entzug endogener Hormone und damit Schutz vor einer dauerhaften Ovarialinsuffizienz. In der Postmenopause wurde Anastrozol (Arimidex™) als Alternative zu Tamoxifen für die adjuvante Behandlung postmenopausaler Frauen mit hormonsensitivem, invasiven Mammakarzinom, die aufgrund eines erhöhten Risikos für Thromboembolien oder wegen Veränderungen des Endometriums nicht mit Tamoxifen behandelt werden können, zugelassen. Die endokrine Therapie sollte erst nach Abschluss der Chemotherapie gegeben werden, da die simultane Gabe eine geringere Effektivität zeigt. „Ältere” Patientinnen profitieren wahrscheinlich nicht von einer chemoendokrinen gegenüber einer alleinigen endokrinen Therapie. Die vorläufigen Empfehlungen erlauben eine recht große Therapiefreiheit.

Abstract

During the recently held 8th International Conference on Primary Therapy of Early Breast Cancer, (March 12-15, 2003 St. Gallen/Switzerland) established recommendations for adjuvant endocrine treatment were confirmed, while new options were introduced. Ovarian ablation, limited for 2 years (e. g. Goserelin, combined with 5 years of Tamoxifen), was suggested as an effective treatment option in premenopausal patients with a hormonsensitive breast cancer. The efficacy of this endocrine regimen is equivalent to CMF-chemotherapy in these patients. In “very” young patients with hormonsensitive tumors, chemotherapy alone is not sufficient. These patients will particularly benefit from endocrine treatment. The reversibility of endocrine treatment is its main advantage, avoiding long lasting symptoms of hormone deficiency. In postmenopausal hormonsensitive patients the aromatase inhibitor Anastrozol (Arimidex™) has been approved as an alternative for patients with contraindications against Tamoxifen (e. g. increased risk of thromboembolism, varicosis, smokers, endometrium changes). The initiation of endocrine should be postponed until the completion of chemotherapy, because combined application reduces the efficacy of adjuvant treatment. “Older” patients will get only limited advantage of chemoendocrine treatment compared to endocrine treatment alone. Preliminary treatment recommendations comprise a wide range of possible treatment options.

Schlüsselwörter

Mammakarzinom - Hormontherapie - Prämenopause - Postmenopause

Key words

Breast cancer - endocrine treatment - premenopause - postmenopause

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Prof. Dr. med. B. Gerber

I. Frauenklinik der LMU München

Maistraße 11

80337 München

Email: bernd.gerber@fk-i.med.uni-muenchen.de