Zusammenfassung
Die adjuvante endokrine Therapie ist eine wichtige Säule der Behandlung des östrogenrezeptorpositiven
Mammakarzinoms. Große Unterschiede weist die Therapie der prämenopausalen Frau gegenüber
der Therapie in der Postmenopause auf. In der postmenopausalen Situation zeigen Aromataseinhibitoren
(AI) gegenüber Tamoxifen zunehmend einen Vorteil. Für prämenopausale Patientinnen
ist die Monotherapie mit AI aufgrund einer eventuellen paradoxen Erhöhung der Östrogensekretion
kontraindiziert. In der endokrinen Therapie prämenopausaler Frauen mit primärem Mammakarzinom
werden Tamoxifen und/oder die Ovarialfunktionssuppression (OFS; GnRH-Analoga, Ovarektomie)
eingesetzt. Problematisch kann die Behandlung perimenopausaler Patientinnen sein.
Es existieren momentan keine allgemeingültigen Therapiestrategien. Insbesondere kann
die Identifizierung des tatsächlichen Menopausestatus nach bereits erfolgter Operation
und Chemotherapie erschwert sein.
Abstract
Adjuvant endocrine treatment plays an important role in the treatment of estrogen
responsive breast cancer. The treatment options for premenopausal women differ from
those for postmenopausal women. Aromatase inhibitors (AI) improve the outcomes in
postmenopausal women, while AI can induce an increase in estrogen secretion and tumor
growth in premenopausal women. The standard therapy during premenopause remains tamoxifen
with or without ovarian suppression by GnRH analogues. Treatment of perimenopausal
breast cancer patients can be more complicated, because it is often difficult to determine
menopausal status.
Schlüsselwörter
Perimenopause - Mammakarzinom - endokrine Therapie - Menopausestatus
Key words
perimenopause - breast cancer - endocrine therapy - menopausal status
Literatur
- 1
Anderson W F, Chatterjee N, Ershler W B et al.
Estrogen receptor breast cancer phenotypes in the Surveillance, Epidemiology, and
End Results Database.
Breast Cancer Res Treat.
2002;
76
27-36
- 2
Burger H G, Hale G E, Robertson D M et al.
A review of hormonal changes during the menopausal transition: focus on findings from
the Melbourne Women's Midlife Health Project (Review).
Hum Reprod Update.
2007;
13
559-565
, Epub 2007, Jul 14
- 3
Burstein H J, Mayer E, Patridge A H et al.
Inadvertent use of aromatase inhibitors in patients with breast cancer with residual
ovarian function: cases and lessons.
Clin Breast Cancer.
2006;
7
158-161
- 4
Carlson R.
Goserelin plus anastrozole for treatment of premenopausal women with hormone receptor
positive recurrent/metastatic breast cancer (Abstract).
Breast Cancer Res Treat.
2004;
88
S237-S238
- 5
Celio L, Martinetti A, Ferrari L et al.
Premenopausal breast cancer patients treated with a gonadotropin-releasing hormone
analog alone or in combination with an aromatase inhibitor: a comparative endocrine
study.
Anticancer Res.
1999;
19 (3B)
2261-2268
- 6
Coates A S, Keshaviah A, Thürlimann B et al.
Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal
women with endocrine-responsive early breast cancer: update of study BIG 1-98.
J Clin Oncol.
2007;
25
486-492
, Epub 2007, Jan 2
- 7
Coombes R C, Kilburn L S, Snowdon C F Intergroup Exemestane Study et al.
Survival and safety of exemestane versus tamoxifen after 2–3 years' tamoxifen treatment
(Intergroup Exemestane Study): a randomised controlled trial.
Lancet.
2007;
369
559-570
Erratum.
Lancet.
2007;
369
906
- 8
Cuzick J, Ambroisine L, Davidson N LHRH-agonists in Early Breast Cancer Overview group
et al.
Use of luteinising-hormone-releasing hormone agonists as adjuvant treatment in premenopausal
patients with hormone-receptor-positive breast cancer: a meta-analysis of individual
patient data from randomised adjuvant trials.
Lancet.
2007;
369
1711-1723
- 9
Early Breast Cancer Trialists' Collaborative Group (EBCTCG) .
Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence
and 15-year survival: an overview of the randomised trials.
Lancet.
2005;
365
1687-1717
- 10
Forbes J F, Cuzick J, Buzdar A Arimidex, Tamoxifen, Alone or in Combination (ATAC)
Trialists' Group et al.
Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer:
100-month analysis of the ATAC trial.
Lancet Oncol.
2008;
9
45-53
- 11
Francis P, Fleming G, Nasi M L et al.
Tailored treatment investigations for premenopausal women with endocrine responsive
(ER+ and/or PGR+) breast cancer: the SOFT, TEXT, and PERCHE trials (Abstract).
The Breast.
2003;
12 (Suppl. 1)
A–P104
- 12
Gnant M F, Mlineritsch B, Luschin-Ebengreuth G Austrian Breast and Colorectal Cancer
Study Group et al.
Zoledronic acid prevents cancer treatment-induced bone loss in premenopausal women
receiving adjuvant endocrine therapy for hormone-responsive breast cancer: a report
from the Austrian Breast and Colorectal Cancer Study Group.
J Clin Oncol.
2007;
25
820-828
, Epub 2006, Dec 11
- 13
Goldhirsch A, Wood W C, Gelber R D et al.
10th St. Gallen conference. Progress and promise: highlights of the international
expert consensus on the primary therapy of early breast cancer 2007 (Review).
Ann Oncol.
2007;
18
1133-1144
- 14
Goss P E, Ingle J N, Pater J L et al.
Late extended adjuvant treatment with letrozole improves outcome in women with early-stage
breast cancer who complete 5 years of tamoxifen.
J Clin Oncol.
2008;
26
1948-1955
Epub 2008; Mar 10.
Erratum.
J Clin Oncol.
2008;
26
3659
- 15
Goswamy D, Conway G.
Premature ovarian failure.
Hum Reprod Update.
2005;
11
391-410
- 16
Jannuzzo M G, Di Salle E, Spinelli R et al.
Estrogen suppression in premenopausal women following 8 weeks of treatment with exemestane
and triptorelin versus triptorelin alone.
Breast Cancer Res Treat.
2009;
113
491-499
- 17
Jonat W, Gnant M, Boccardo F et al.
Effectiveness of switching from adjuvant tamoxifen to anastrozole in postmenopausal
women with hormone-sensitive early-stage breast cancer: a meta-analysis.
Lancet Oncol.
2006;
7
991-996
Erratum.
Lancet Oncol.
2007;
8
6
- 18
King M C, Wieand S, Hale K et al.
Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1
and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer
Prevention Trial. National Surgical Adjuvant Breast and Bowel Project.
JAMA.
2001;
286
2251-2256
- 19
Klijn J G, Blamey R W, Boccardo F Combined Hormone Agents Trialists' Group and the
European Organization for Research and Treatment of Cancer et al.
Combined tamoxifen and luteinizing hormone-releasing hormone (LHRH) agonist versus
LHRH agonist alone in premenopausal advanced breast cancer: a meta-analysis of four
randomized trials.
J Clin Oncol.
2001;
19
343-353
- 20
Ortmann O, Cufer T, Dixon J M et al.
Adjuvant endocrine therapy for perimenopausal women with early breast cancer.
Breast.
2009;
18
2-7
- 21
Sharma R, Hamilton A, Beith J.
LHRH agonists for adjuvant therapy of early breast cancer in premenopausal women (Review).
Cochrane Database Syst Rev.
2008;
(4)
CD004562
- 22
Smith I E, Dowsett M, Yap Y S et al.
Adjuvant aromatase inhibitors for early breast cancer after chemotherapy-induced amenorrhoea:
caution and suggested guidelines.
J Clin Oncol.
2006;
24
2444-2447
- 23
Sowers M R, Eyvazzadeh A D, McConnell D et al.
Anti-mullerian hormone and inhibin B in the definition of ovarian aging and the menopause
transition.
J Clin Endocrinol Metab.
2008;
93
3478-3483
, Epub 2008; Jul 1
- 24
Early Breast Cancer Trialists' Collaborative Group .
Tamoxifen for early breast cancer: an overview of the randomised trials.
Lancet.
1998;
351
1451-1467
- 25
Walshe J M, Denduluri N, Swain S M.
Amenorrhea in premenopausal women after adjuvant chemotherapy for breast cancer (Review).
J Clin Oncol.
2006;
24
5769-5779
, Epub 2006, Nov 27
- 26
Winer E P, Hudis C, Burstein H J et al.
American Society of Clinical Oncology technology assessment on the use of aromatase
inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive
breast cancer: status report 2004 (Review).
J Clin Oncol.
2005;
23
619-629
, Epub 2004, Nov 15
- 27
Jud S M, Schrauder M G, Lux M P et al.
Signalhemmer in der gynäkologischen Onkologie.
Geburtsh Frauenheilk.
2007;
67
R73-R100
Prof. Dr. O. Ortmann
Klinik für Frauenheilkunde und Geburtshilfe
Universität Regensburg
Caritas Krankenhaus St. Josef
Landhuter Straße 63
93053 Regenburg
Email: olaf.ortmann@klinik.uni-regensburg.de
