Systemische Therapie von prämenopausalen Patientinnen mit hormonrezeptorpositivem, HER2-negativem Brustkrebs in den Frühstadien – Kontroversen und Standards in der Krankenversorgung

Zusammenfassung

Die adjuvante endokrine Behandlung von prämenopausalen Patientinnen mit einem hormonrezeptorpositiven, HER2-negativen (HR-pos./HER2-neg.) Mammakarzinom unterliegt bei bestehender Ovarialfunktion einigen Besonderheiten. Als therapeutische Optionen stehen Tamoxifen mit oder ohne GnRH-Analogon und Aromatasehemmer mit GnRH-Analogon zur Verfügung. Des Weiteren wird die Ovarialfunktion durch eine vorherige Chemotherapie beeinflusst. Sowohl die Indikation für GnRH-Analoga in Kombination mit Tamoxifen als auch die Indikation für Aromatasehemmer (+GnRH-Analoga) sind für Patientinnen mit einem erhöhten Rückfallrisiko vorgesehen.

In nationalen und internationalen Leitlinien und Therapieempfehlungen ist jedoch keine klare Grenze für ein mittleres oder hohes Risiko definiert, sodass viele Therapieentscheidungen für jede Patientin individuell getroffen werden. Dies spiegelt sich auch in einer großen nationalen und internationalen Variabilität z. B. beim Einsatz von Aromatasehemmern + GnRH-Analoga wider.

Diese Übersichtsarbeit fasst die Datenlage zu den abgeschlossenen Studien (z. B. SOFT, TEXT, EBCTCG-Metaanalysen), den aktuellen Multigentest-Studien (TailorX, RxPonder, ADAPT) zusammen, diskutiert die Rationale für aktuell durchgeführte Studien (z. B. CLEAR-B) und gibt einen Ausblick auf künftige Fragestellungen.

Abstract

In patients with existing ovarian function, there are some special aspects to adjuvant endocrine therapy in premenopausal patients with hormone receptor-positive, HER2-negative (HR pos./HER2 neg.) breast cancer. Treatment options include tamoxifen with or without a GnRH analog, and aromatase inhibitors with a GnRH analog. Furthermore, ovarian function is affected by previous chemotherapy. Both aromatase inhibitors (+GnRH analogs) and GnRH analogs in combination with tamoxifen are supposed to be indicated for patients at increased risk of recurrence.

However, national and international guidelines and therapy recommendations do not provide a clear definition of intermediate or high risk; as a result, therapy decisions are often made for each patient on an individual basis. This is also reflected in the considerable variability at national and international levels, e.g., with regard to the use of aromatase inhibitors + GnRH analogs.

This review summarizes the data on completed studies (e.g., SOFT, TEXT, EBCTCG meta-analyses) and the current multigene testing studies (TailorX, RxPonder, ADAPT), discusses the rationale for current studies (e.g., CLEAR-B), and looks ahead to future questions.

Schlüsselwörter

Brustkrebs - prämenopausale Therapie - Aromatasehemmer - Tamoxifen - GnRH

Keywords

breast cancer - premenopausal therapy - aromatase inhibitor - tamoxifen - GnRH

Publication History

Received: 27 February 2023

Accepted after revision: 03 April 2023

Article published online:
22 March 2024

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