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Erschienen in: Der Onkologe 12/2021

01.11.2021 | Mammakarzinom | Leitthema

Prädiktive und prognostische Faktoren in der Therapie des frühen Mammakarzinoms

verfasst von: Prof. Dr. med. Christoph Thomssen

Erschienen in: Der Onkologe | Ausgabe 12/2021

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Zusammenfassung

Hintergrund

Die adjuvante Therapie beim frühen Mammakarzinom hat zu einer substanziellen Verbesserung der Überlebenswahrscheinlichkeit geführt, allerdings auf Kosten einer erheblichen Übertherapie. Durch prognostische und prädiktive Faktoren muss die Therapie auf die Patientinnen beschränkt werden, die einen hohen absoluten Nutzen haben.

Ergebnisse

Die meisten Therapieentscheidungen ergeben sich aus Tumorausdehnung (TNM) und Tumorbiologie (Grading) sowie aus den immunhistochemischen Zusatzanalysen für Östrogenrezeptor (ER), Progesteronrezeptor (PR), HER2 und Ki-67 – idealerweise aus dem Biopsiematerial (CNB, „Stanzbiopsie“) – und den Einteilungen in „luminal-like“, HER2-positive und tripelnegative Karzinome. Die Differenzierung zwischen „luminal-A-like“ (Low-Risk-) und „luminal-B-like“ (High-Risk‑)Karzinomen erfolgt zunächst durch Grading, Tumorgröße, Ki-67, PR-Expression. Bei weniger als 10% aller frühen Mammakarzinome werden für die Therapiefestlegung Zusatzbefunde benötigt wie internetbasierte Rechenalgorithmen, Ki-67-Dynamik, uPA/PAI‑1 oder Genexpressionsprofile. Bei Nachweis einer Keimbahnmutation im BRCA1-oder BRCA2-Gen kann bei lokal fortgeschrittenen HER2-negativen Karzinomen eine Therapie mit Inhibitoren der Poly(Adenosindiphosphat-Ribose)-Polymerase (PARP) indiziert sein. In der metastasierten Situation sind für den Einsatz zielgerichteter Therapie weitere Analysen notwendig: PD-L1-Expression (mTNBC), PIK3CA-Mutation am Tumor (ER-positiv), Keimbahnanalyse für BRCA1/2 (HER2-negativ); in seltenen Fällen auch ESR1-Mutation, Mikrosatelliteninstabilität und Nachweis einer NTRK-Fusion.
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Metadaten
Titel
Prädiktive und prognostische Faktoren in der Therapie des frühen Mammakarzinoms
verfasst von
Prof. Dr. med. Christoph Thomssen
Publikationsdatum
01.11.2021
Verlag
Springer Medizin
Erschienen in
Der Onkologe / Ausgabe 12/2021
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-021-01054-y

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