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

Hans-Christian Kolberg; Andreas Schneeweiss; Tanja N. Fehm; Achim Wöckel; Jens Huober; Constanza Pontones; Adriana Titzmann; Erik Belleville; Michael P. Lux; Wolfgang Janni; Andreas D. Hartkopf; Florin-Andrei Taran; Markus Wallwiener; Friedrich Overkamp; Hans Tesch; Johannes Ettl; Diana Lüftner; Volkmar Müller; Florian Schütz; Peter A. Fasching; Sara Y. Brucker

doi:10.1055/a-0982-9991

TumorDiagnostik & Therapie, Inhaltsverzeichnis

TumorDiagnostik & Therapie 2019; 40(07): 459-472
DOI: 10.1055/a-0982-9991

Thieme Onkologie aktuell

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

Update Breast Cancer 2019 Part 3 – Current Developments in Early Breast Cancer: Review and Critical Assessment by an International Expert Panel

Hans-Christian Kolberg

¹Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop

,

Andreas Schneeweiss

²National Center for Tumor Diseases, Division Gynecologic Oncology, University-Hospital and German Cancer Research Center Heidelberg, Heidelberg

,

Tanja N. Fehm

³Department of Gynecology and Obstetrics, University-Hospital Düsseldorf, Düsseldorf

,

Achim Wöckel

⁴Department of Gynecology and Obstetrics, University-Hospital Würzburg, Würzburg

,

Jens Huober

⁵Department of Gynecology and Obstetrics, Ulm University-Hospital, Ulm

,

Constanza Pontones

⁶Erlangen University-Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen

,

Adriana Titzmann

⁶Erlangen University-Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen

,

Erik Belleville

⁷ClinSol GmbH & Co KG, Würzburg

,

Michael P. Lux

⁸Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St.-Josefs-Krankenhaus, Salzkotten

,

Wolfgang Janni

⁵Department of Gynecology and Obstetrics, Ulm University-Hospital, Ulm

,

Andreas D. Hartkopf

⁹Department of Obstetrics and Gynecology, University of Tübingen, Tübingen

,

Florin-Andrei Taran

⁹Department of Obstetrics and Gynecology, University of Tübingen, Tübingen

,

Markus Wallwiener

¹⁰Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg

,

Friedrich Overkamp

¹¹OncoConsult Hamburg GmbH, Hamburg

,

Hans Tesch

¹²Oncology Practice at Bethanien-Hospital Frankfurt, Frankfurt

,

Johannes Ettl

¹³Department of Obstetrics and Gynecology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich

,

Diana Lüftner

¹⁴Charité University-Hospital, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin

,

Volkmar Müller

¹⁵Department of Gynecology, Hamburg-Eppendorf-University Medical Center, Hamburg

,

Florian Schütz

¹⁰Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg

,

Peter A. Fasching

⁶Erlangen University-Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen

,

Sara Y. Brucker

⁹Department of Obstetrics and Gynecology, University of Tübingen, Tübingen

› Institutsangaben

Abstract

Zusammenfassung

Die Behandlung von Mammakarzinom-Patientinnen in der kurativen Situation ist in vielfacher Hinsicht besonders. Hierbei ist die lokale Therapie mit Operation und Strahlentherapie 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. Letztendlich soll die Behandlung von frühen Mammakarzinom-Patientinnen immer personalisierter werden. Prognostische genexpressionistische Tests könnten möglicherweise Therapieentscheidungen unterstützen. Ebenso muss überlegt werden, wie ein möglicher Einsatz von neuen Therapien, wie Checkpoint-Inhibitoren und CDK4/6-Inhibitoren, in der Praxis aussehen könnten, sobald hier 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 Mammakarzinom-Patientinnen 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

Volltext

Referenzen

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