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Senologie - Zeitschrift für Mammadiagnostik und -therapie 2024; 21(01): 61-74
DOI: 10.1055/a-2238-9693
Übersicht

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

Systemic Therapy of Premenopausal Patients with Early Stage Hormone Receptor-Positive, HER2-Negative Breast Cancer – Controversies and Standards in Healthcare
Volkmar Müller
1   Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
,
Peter A. Fasching
2   Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
,
Naiba Nabieva
3   Novartis Pharma GmbH, Nürnberg, Germany
,
Tanja N. Fehm
4   Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
,
Marc Thill
5   Department of Gynecology and Gynecological Oncology, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
,
Marcus Schmidt
6   Universitäts-Frauenklinik Mainz, Mainz, Germany
,
Thorsten Kühn
7   Filder-Klinik, Filderstadt-Bonlanden, Germany
,
Maggie Banys-Paluchowski
8   Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
,
Erik Belleville
9   ClinSol GmbH & Co KG, Würzburg, Germany
,
Ingolf Juhasz-Böss
10   Universitäts-Frauenklinik Freiburg, Freiburg, Germany (Ringgold ID: RIN14879)
,
Michael Untch
11   Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany (Ringgold ID: RIN62473)
,
Hans-Christian Kolberg
12   Department of Gynecology and Obstetrics, Marienhospital Bottrop, Bottrop, Germany
,
Nadia Harbeck
13   Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, München, Germany
,
Bahriye Aktas
14   Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
,
Elmar Stickeler
15   Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany
,
Julia Kreuzeder
3   Novartis Pharma GmbH, Nürnberg, Germany
,
Andreas D. Hartkopf
16   Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany (Ringgold ID: RIN27197)
,
Wolfgang Janni
16   Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany (Ringgold ID: RIN27197)
,
Nina Ditsch
17   Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)
› Author AffiliationsSupported by: Novartis
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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

© 2023. The Author(s). This article was originally published by Thieme in Geburtsh Frauenheilk 2023; 83: 673–685 as an open access article under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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