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Standards in der adjuvanten Systemtherapie des Mammakarzinoms

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Weiterbildung Onkologie

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Zusammenfassung

Hintergrund. Ziel der adjuvanten Therapie ist die Heilung. Durch die adjuvante Chemotherapie wird eine potenziell-systemische Mikrometastasierung kurativ behandelt. Standardtherapie. Standard ist eine anthrazyklin- (Epirubicin, Doxorubicin) und taxan- haltige (Paclitaxel und Docetaxel) Chemotherapie. Mögliche Nebenwirkungen (Übelkeit/ Erbrechen, Myelosuppression und Alopezie) und Spättoxizitäten wie die Kardiotoxizität sowie sekundäre Leukämien bei den Anthrazyklinen und Myelosuppression, Fatique, Alopezie und Polyneuropathie für Paclitaxel und die Hämatotoxizität bei Docetaxel müssen berücksichtigt werden.

Neue Ansätze. Zur Therapie des Mammakarzinoms werden zunehmend zielgerichtete Substanzen eingesetzt. Der Her2-Inhibitor (Her2: „human epidermal growth factor receptor 2“) Trastuzumab ist bei Überexpression des Her2-Rezeptors seit 2005 Standard. Aktuell wurde dieser Standard durch eine duale Blockade mit Pertuzumab in der neodjuvanten Therapiesituation erweitert. Weitere Substanzen, wie PARP- (Poly(ADP-Ribose)-Polymerase 1; ADP: Adenosindiphosphat], PIK- (Phosphoinositid-3-Kinase) und CDK4/6-Inhibitoren (CDK: zy- klinabhängige Kinase), werden zurzeit in klinischen Studien untersucht.

Resümee. Insgesamt steht heutzutage die Tumorbiologie im Vordergrund der Therapieplanung. Die Behandlung älterer, schwangerer oder männlicher Patienten stellt eine besondere Herausforderung dar.

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Literatur

  1. Fisher B, Ravdln RG, Ausman RK et al (1968) Surgical adjuvant chemotherapy In cancer of the breast: results of a decade of cooperative Investigation. Ann Surg 168(3):337–356

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Reinisch M, Kümmels (In Vorbereitung) Adjuvante Chemotherapie des Mammakarzinoms. In: Elllng D (ed) Medikamentöse Therapie des invasiven Mammakarzinoms unter dem Aspekt der Anthrazykline. Unimed, Bremen

    Google Scholar 

  3. Poole CI, Earl HM, Hiller L (2006) Epi- rubicin and cyclophosphamide, methotrexate and fluorouracil as adjuvant therapy for early breast cancer. NEnglJ Med 355:1851–1862

    Article  CAS  Google Scholar 

  4. Wolff AC, Blackford AL. Visvanathan K (2015) Risk of marrow neoplasms after adjuvant breast cancer therapy: the National Comprehensive Cancer Network experience. J Clin Oncol 33(4):340–348

    Article  PubMed  Google Scholar 

  5. Swain SM, Whaley FS, Ewer MS (2003) Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 97(11):2869–2879

    Article  CAS  PubMed  Google Scholar 

  6. Early Breast Cancer Triallsts’ Collaborative Group (EBCTCG), Peto R, Davies C, Godwin J (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of longterm outcome among 100,000 women in 123 randomised trials. Lancet 379(9814):432–444

    Article  Google Scholar 

  7. Early Breast Cancer Trialists’ Collaborative Group (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717

    Article  Google Scholar 

  8. Martin M, Plenkowski T, Mackey J et al (2005) Adjuvant docetaxel for node-positive breast cancer. N Engl J Med 352(22):2302–2313

    Article  CAS  PubMed  Google Scholar 

  9. Sparano JA, Wang M, Martino S et al (2008) Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med 358(16):1663–1671

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sparano JA, Zhao F, Martino S (2015) Long-term follow-up of the El 199 phase III trial evaluating the role of taxane and schedule in operable breast cancer. J Clin Oncol 33(21):2353–2360

    Article  CAS  PubMed  Google Scholar 

  11. Bergh J, Wiklund T, Erikstein B (2000) Tailored fluorouracil, epirubicin, and cyclophosphamide compared with marrow-supported high-dose chemotherapy as adjuvant treatment for high-risk breast cancer: a randomised trial. Scandinavian Breast Group 9401 study. Lancet 356(9239):! 3841391

    Google Scholar 

  12. Moebus V, Schneeweiss A, Bols A du (2012) Ten year follow-up analysis of intense dose-dense adjuvant ETC (Epirubicin (E), Paclitaxel (T) and Cyclophosphamide (C)) confirms superior DFS and OS benefit In comparison to conventional dosed chemotherapy in high-risk breast cancer patients with > 4 positive lymph nodes. Abstract S3-4. San Antonio Breast Cancer Symposium (SABCS), Dec 4–8,2012; San Antonio, TX

    Google Scholar 

  13. Citron ML, Berry DA, Cirrincione C (2003) Randomized trial of dosedense vs conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 21 (8):1431–1439

    Article  CAS  PubMed  Google Scholar 

  14. Cognetti F, Bruzzi R De Plácido S (2013) Epirubicin and cyclophosphamide (EC) followed by paclitaxel (T) versus fluorouracil, epirubicin and cyclophosphamide (FEC) followed byT, all given every 3 weeks or 2 weeks, in node-positive early breast cancer (BC) patients (pts). Final results of the Gruppo Italiano Mammella (GIM)-2 randomized phase III study, [S5-06 J, SABCS 2013. Cancer Res 73:S5–S06

    Article  Google Scholar 

  15. Swain SM, Tang G, Geyer CE Jr (2013) Definitive results of a phase III adjuvant trial comparing three chemotherapy regimens In women with operable, node-positive breast cancer: the NSABP B-38 trial. Clin Oncol 31 (26):3197–3204

    Article  CAS  Google Scholar 

  16. Budd GT, Barlow WE, Moore HC (2015) SWOG S0221: a phase III trial comparing chemotherapy schedules in high-risk early-stage breast cancer. J Clin Oncol 33(1):58–64

    Article  PubMed  Google Scholar 

  17. Lehmann BD, Pietenpol JA, Tan AR (2015) Triple-negative breast cancer: molecular subtypes and new targets for therapy. Am Soc Clin Oncol Educ Book 35:e31–39. DOI 10.14694/Ed- Book_AM.2015.35.e31

    Article  Google Scholar 

  18. Minckwitz G von, Schneeweiss A, Salat C et al (2013) A randomized phase II trial investigating the addition of carboplatin to neoadjuvant therapy for triple-negative and HER2-positive early breast cancer (Gepar Six- to). Abstract 1004. J Clin Oncol Suppl 31:15 s

    Google Scholar 

  19. Minckwitzvon.TimmsK, Untch M (2015) Prediction of pathological complete response (pCR) by homologous recombination deficiency (HRD) after carboplatin-containing neoadjuvant chemotherapy in patients with TNBC - Results from GeparSixto. American Society of Clinical Oncology (ASCO), Chicago, 29.05 02.06.2015

    Google Scholar 

  20. Sikov WM, Berry DA, Perou CM et al (2013) Impact of the addition of carbo-platin (Cb) and/or bevacizumab (B) to neoadjuvant weekly paditaxel (P) followed by dose-dense AC on pathologic complete response (pCR) rates in triple-negative breast cancer (TNBC): CALGB 40603 (Alliance). Abstract S5-01. San Antonio Breast Cancer Symposium, December 2013, San Antonio, TX

    Google Scholar 

  21. Untch M, Jackisch C, Schneeweiß A (2014) A randomized phase III trial comparing neoadjuvant chemotherapy with weekly nanopartide-based paditaxel with solvent-based paditaxel followed by anthracyline/cydophosphamlde for patients with early breast cancer (GeparSepto); GBG 69. Abstract [PD2-6], San Antonio Breast Cancer Symposium (SABCS), Dezember 2014

    Google Scholar 

  22. Romond EH, Perez EA, Bryant J et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353:1673–1684

    Article  CAS  PubMed  Google Scholar 

  23. Gianni L, Dafni U, Gelber RD (2011) Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer, a 4-year follow-up of a randomised controlled trial. Lancet Oncol 12(3):236–244

    Article  CAS  PubMed  Google Scholar 

  24. Gianni L (2015) Final overall survival (OS) analysis from the CLEOPATRA study of first-line (1L) pertuzu mab (Ptz), trastuzumab (T), and docetaxel (D) in patients (pts) with HER2-positive metastatic breast cancer (MBC). Abstract 350O_PR. ESMO, Madrid, Spanien, Dezember 2015

    Google Scholar 

  25. Dang C, Iyengar N, Datko F (2015) Phase II study of paditaxel given once per week along with trastuzumab and pertuzu mab in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. J Clin Oncol 33(5):442–447

    Article  CAS  PubMed  Google Scholar 

  26. Gianni L, Pienkowski T, Im YH et al (2012) Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positlve breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol 13:25–32

    Article  CAS  PubMed  Google Scholar 

  27. Gianni LTadeusz Pienkowski T, lm YH (2015) Five-year analysis of the phase II NeoSphere trial evaluating four cycles of neoadjuvant docetaxel (D) and/or trastuzumab (T) and/or pertuzumab (P). Abstract 505. J Clin Oncol Suppl 33:505

    Google Scholar 

  28. Gray RG, Rea D, Handley K et al (2013) aTTom: long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years in 6,953 women with early breast cancer. Abstract 5. J Clin Oncol Suppl 31(15)

    Google Scholar 

  29. Smith I (2014) How long is long enough? Defining optimal duration and selection of adjuvant endocrine therapy for breast cancer. 2014 ASCO Annual Meeting, Chicago, 30.05–03.06.2014

    Google Scholar 

  30. Goss PE, Ingle JN, Martino S (2013) Impact of premenopausal status at breast cancer diagnosis in women entered on the placebo-controlled NCIC CTG MA17 trial of extended adjuvant letrozole. Ann Oncol 24(2):355–361

    Article  CAS  PubMed  Google Scholar 

  31. Arbeitsgemeinschaft Gynäkologische Onkologie e.V. (AGO) (2015) Adjuvante endokrine Therapie bei prä- und postmenopausalen Patientinnen. Guidelines Breast, Version 2015.1 D. http://www.ago-online.de/fileadmin/downloads/leitIinien/mamma/maerz2015/de/2015D_10_Adjuvante_endokrine_Theraple_prae-_und_postmeno-pausaler_Patientinnen.pdf. Zugegriffen: 07.09.2015

    Google Scholar 

  32. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2015) Aromatase Inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. Lancet pli:S0140-6736(15)61074–1

    Google Scholar 

  33. Amant F, Loibl S, Neven P (2012) Breast cancer in pregnancy. Lancet 379(9815):570–579

    Article  PubMed  Google Scholar 

  34. Amant F, MinckwitzG von, Han SN (2013) Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an International collaborative study. J Clin Oncol 31(201:2532–2539

    Article  Google Scholar 

  35. Loibl S, Han SN, MinckwitzG von (2012) Treatment of breast ca ncer during pregnancy: an observational study. Lancet Oncol 13(9):887–896

    Article  CAS  PubMed  Google Scholar 

  36. Giordano SH, Cohen DS, Buzdar AU (2004) Breast carcinoma in men: a population-based study. Cancer 101(1):51–57

    Article  PubMed  Google Scholar 

  37. Cutuli B (2007) Strategies in treating male breast cancer. Expert Opin Pharmacother 8(2):193–202

    Article  CAS  PubMed  Google Scholar 

  38. Fentiman IS, Fourquet A, Hortobagyi GN (2006) Male breast cancer. Lancet 367(95101:595–604

    Article  Google Scholar 

  39. Korde LA, Zujewski JA, Kamin L (2010) Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol 28(12):2114–2122

    Article  PubMed  PubMed Central  Google Scholar 

  40. GBG (2015) MALE. http://www.germanbreastgroup.de/studien/adjuvant/male.html. Zugegriffen: 29.08.2015

    Google Scholar 

  41. Muss HB, Berry DA, Cirrincione CT et al (2009) Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med 360:2055–2065

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Minckwitz G von, ReimerT, Poten- berg J (2014) The phase III ICE study: adjuvant ibandronate with or without capecitabine in elderly patients with moderate or high risk early breast cancer. Abstract [S3–04]. San Antonio Breast CancerSymposium (SABCS), Dezember 2014

    Google Scholar 

  43. Loibl S, Minckwitz G von, Harbeck N et al (2008) Clinical feasibility of (neo)adjuvant taxane-based chemotherapy in older patients: analysis of > 4,500 patients from four German randomized breast cancer trials. Breast Cancer Res 10:R77

    Article  PubMed  PubMed Central  Google Scholar 

  44. Reinisch M, Minckwitz G von, Harbeck N et al (2013) Side effects of standard adjuvant and neoadjuvant chemotherapy regimens according to age groups in primary breast cancer. Breast Care 8(1):60–66

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Senologie/interdisziplinäres Brustzentrum, Kliniken Essen Mitte, Essen

    M. Reinisch & S. Kümmel

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  1. M. Reinisch
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  2. S. Kümmel
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Editor information

Editors and Affiliations

  1. Marienhospital Herne – Klinik für Strahlentherapie, Ruhr-Universität Bochum, Herne, Deutschland

    Irenäus A. Adamietz

  2. Zentrum der Chirurgie – Universität Frankfurt, Universitätsklinikum Frankfurt, Frankfurt, Deutschland

    Wolf O. Bechstein

  3. Strahlentherapie Spez Onkol, Medizinische Hochschule Hannover, Göttingen, Deutschland

    Hans Christiansen

  4. Urologikum Lübeck, Lübeck, Deutschland

    Christian Doehn

  5. Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Deutschland

    Andreas Hochhaus

  6. Interdisziplin. Tumorzentrum, Universität Mannheim, TagesTherapieZentrum TTZ, Mannheim, Deutschland

    Ralf-Dieter Hofheinz

  7. Klinik für Gynäkologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    Werner Lichtenegger

  8. Cancer Center, Universitätsklinikum Leipzig, Leipzig, Deutschland

    Florian Lordick

  9. Klinik für Dermatologie, Universitätsklinikum Essen, Essen, Deutschland

    Dirk Schadendorf

  10. Klinik Gynäkologie/Geburtshilfe, HELIOS Klinikum Berlin-Buch, Berlin, Deutschland

    Michael Untch

  11. Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    Christian Wittekind

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Reinisch, M., Kümmel, S. (2016). Standards in der adjuvanten Systemtherapie des Mammakarzinoms. In: Adamietz, I., et al. Weiterbildung Onkologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49415-8_17

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  • DOI: https://doi.org/10.1007/978-3-662-49415-8_17

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-49414-1

  • Online ISBN: 978-3-662-49415-8

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