Ein zentraler Baustein der Behandlung - Medikamentöse Therapie von Frauen mit primärem Mammakarzinom

Zusammenfassung

Die medikamentöse Behandlung des Mammakarzinoms mit Chemotherapie und Antihormontherapie ist neben der Operation und Strahlentherapie zentraler Bestandteil der Therapie von Mammakarzinompatientinnen. Die Therapie richtet sich maßgeblich nach allgemeinen Prognoseparametern wie Tumorgröße, axillärem Lymphknotenstatus, Grading, Steroidhormonrezeptorstatus und Alter der Patientin. Die Therapieentscheidung sollte im Rahmen einer interdisziplinären Konferenz - an der der Pathologe, der Operateur, der Gynäkologe, der Internist, der Radiologe und der Strahlentherapeut teilnehmen sollten - individuell festgelegt werden. Es gilt: Alle Patientinnen, deren Prognose durch eine Zytostatikagabe nachgewiesenerweise verbessert werden kann, sollten eine Chemotherapie erhalten. Dazu zählen Patientinnen mit steroidhormonrezeptornegativem Mammakarzinom, Patientinnen mit einem positiven axillären Nodalstatus oder einem großen Primärtumor und junge Patientinnen. Eine Antihormontherapie mit Tamoxifen sollte bei allen steroidhormonrezeptorpositiven Patientinnen eingesetzt werden. Liegt eine Kontraindikation für Tamoxifen vor, sind die neueren Aromatasehemmer indiziert. Neue adjuvante Therapieformen wie eine Immuntherapie mit Trastuzumab werden in der kurativen Situation momentan geprüft. Daten hierzu stehen noch aus.

Summary

Chemotherapy and antihormonal treatment of breast cancer is besides surgery and radiation an essential part of the treatment of primary breast cancer. The decision for treatment depends on common prognostic parameters like tumor size, axillary lymph node status, grading, estrogen and progesteron receptor and age of the patient. The decision between chemotherapy or antihormonal treatment should be made through an established interdisciplinary tumor conference together with a gynecologist, internist, radiologist, pathologist, and radiation oncologist. Chemotherapy is indicated in women with breast cancer, whose prognosis can be improved by the treatment. Estrogen/progesteron receptor negative breast cancer, positive axillary lymph node status, large tumor size and young patients are reasons for chemotherapy. Tamoxifen should be applied to women with estrogen or progesteron receptor positive breast cancer. Aromatase inhibitors are an option for women with contraindication versus tamoxifen. Newer adjuvant therapies like immunotherapy with trastuzumab are actually studied in active clinical trials. Data are still pending.

Key Words

breast cancer therapy - chemotherapy - antihormonal treatment - estrogen receptor positive breast cancer - tamoxifen - aromatase inhibitors - immunotherapy

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1 multiple outcomes of raloxifene evaluation

2 study of tamoxifen and raloxifene

3 goserelin and ibandronate plus screening versus screening alone

4 raloxifene and foserelin in preventing breast cancer in women with a family history of breast cancer

5 international breast cancer intervention study

6 cancer and leukemia group B

7 breast cancer international research group

8 national surgical adjuvant breast and bowel project

9 preoperative epirubicin paclitaxel aranesp

10 german preoperative adriamycin docetaxel - TRIO

11 arimidex, tamoxifen alone or in combination

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