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Einsatz neuer Substanzen in der Schwangerschaft

Targeted therapy for breast cancer during pregnancy

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Aufgrund des steigenden Alters Schwangerer ist eine zunehmende Anzahl an Patientinnen mit Mammakarzinom bei gleichzeitig bestehender Schwangerschaft zu beobachten. Zielgerichtete Therapien haben außerhalb der Schwangerschaft einen größeren Stellenwert bekommen, Trastuzumab konnte für Patientinnen mit Her2-positivem Rezeptorstatus die Prognose wesentlich verbessern. Zum Einsatz in der Schwangerschaft liegen bislang wenige Einzelberichte vor, denen zufolge ein Teil der Patientinnen einen unauffälligen Schwangerschaftsverlauf aufwies. Die am häufigsten beobachtete Nebenwirkung unter Trastuzumab war das Oligo- bzw. Anhydramnion. In einem Fallbericht mit dem Tyrosinkinasehemmer Lapatinib verlief die Schwangerschaft unkompliziert, ein gesundes Kind wurde geboren. Eine antiangiogenetische Therapie ist in der Schwangerschaft streng kontraindiziert, nicht zuletzt wurde dies durch den Einsatz von Thalidomid (ConterganTM) gelernt. Dennoch wurde bei einer Schwangeren Bevacizumab lokal am Auge eingesetzt, dabei wurden Nebenwirkungen oder Folgeschäden nicht beobachtet. Um die wenigen Daten gezielt zu bündeln und in die Beratung nachfolgender Schwangerer mit Mammakarzinom einbeziehen zu können, sollten alle Patientinnen mit einem Mammakarzinom in der Schwangerschaft in die Registerstudie der German Breast Group (GBG) eingebracht werden.

Abstract

In large part because of the general age increase among pregnant women, the number of pregnant breast cancer patients has risen. Specific goal-oriented treatment methods for nonpregnant patients have led to significant results; for example, trastuzumab can vastly improve the prognosis of patients with HER2-positive receptor status. But for pregnant patients, there has so far been very little anecdotal evidence of applied therapies that have not exhibited an obstruction to the pregnancy. The most commonly observed side effect of trastuzumab is oligohydramnios or anhydramnios. In a case report involving lapatinib, a tyrosine kinase inhibitor, the pregnancy was uneventful, and a healthy child was born. Antiangiogenetic therapy during pregnancy is strongly contraindicated; this was made known through the use of thalidomide (Contergan). Nevertheless, bevacizumab was locally applied to a pregnant patient’s eye. No side effects or harmful after-effects have been reported for this form of therapy. All patients with breast cancer during pregnancy should be recorded in the German Breast Group’s study register in order to accurately assemble current case report data and thereby help enable thorough consultations for future pregnant breast cancer patients.

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 235638, Lübeck, Deutschland

    D. Fischer, C. Dittmer, N. Bündgen, K. Diedrich, M. Thill & K. Röder

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  1. D. Fischer
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  2. C. Dittmer
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  3. N. Bündgen
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  4. K. Diedrich
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  5. M. Thill
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  6. K. Röder
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Correspondence to D. Fischer.

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Fischer, D., Dittmer, C., Bündgen, N. et al. Einsatz neuer Substanzen in der Schwangerschaft. Gynäkologe 42, 688–693 (2009). https://doi.org/10.1007/s00129-009-2362-6

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  • DOI: https://doi.org/10.1007/s00129-009-2362-6

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