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DOI: 10.1055/a-2238-3199
Identification of Patients with Early HR+ HER2− Breast Cancer at High Risk of Recurrence
Identifizierung von Patientinnen mit HR+, HER2− Brustkrebs im Frühstadium mit hohem Rezidivrisiko Eli Lilly and Company – https://doi.org/10.13039/100004312![](https://www.thieme-connect.de/media/gebfra/202402/lookinside/thumbnails/10-1055-a-2238-3199_gf-1.jpg)
Abstract
Breast cancer incidence has increased in the last two decades and, simultaneously, survival has improved due to earlier detection and improved treatment options. Despite this improvement, locoregional recurrences and distant metastases occur in up to 10 and 30% of women diagnosed with early breast cancer, respectively. Around 70% of breast cancers are hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−), and associated with a persistent risk of relapse up to 20 years after diagnosis/initial treatment. We conducted a narrative review by combining PubMed searches with our clinical experience to describe patient characteristics, biomarkers, and genomic profiling tools available to clinicians for the identification of patients with HR+, HER2− early breast cancer at high risk of recurrence and to provide recommendations to classify patients into recurrence risk categories. National and international treatment guidelines are also summarised. Accurate assessment of the risk of recurrence in these patients is crucial as the predicted risk guides treatment decisions; imprecise estimations can result in over- or undertreatment, with either scenario having negative consequences for patients. Multiple prognostic tools and factors are recommended for early breast cancer, and no single test provides accurate prognosis in isolation. Since no single test can provide accurate prognosis in isolation, a combination of tools should be used. Risk thresholds are important to guide optimised and balanced therapeutic decisions in HR+, HER2− early breast cancer. However, prognostic assessment should be performed on a case-by-case basis, making patient-specific prognostic approaches essential to avoid over- or undertreatment.
Zusammenfassung
Die Inzidenz von Brustkrebs ist in den letzten 2 Jahrzehnten gestiegen; gleichzeitig hat sich das Überleben durch frühere Erkennung und bessere Therapiemöglichkeiten verbessert. Trotz dieser Verbesserungen treten lokoregionäre Rezidive sowie Fernmetastasen bei bis zu 10 resp. 30% aller mit Brustkrebs im Frühstadium diagnostizierten Frauen auf. Rund 70% aller Brustkrebsfälle sind HR+ (hormonrezeptorpositiv), HER2− (humaner epidermaler Wachstumsfaktorrezeptor 2 negativ) und sind somit mit einem anhaltenden Rezidivrisiko assoziiert, das bis zu 20 Jahren nach der Diagnose/Erstbehandlung anhält. Wir führten eine narrative Übersichtsarbeit durch und kombinierten dabei unsere Suche in PubMed mit unseren klinischen Erfahrungen, um die Patientinnencharakteristika, Biomarker und Instrumente zur Analyse von Genomprofilen, die Klinikärztinnen und -ärzten zur Identifizierung von Patientinnen mit HR+, HER2− frühem Mammakarzinom mit einem hohen Rezidivrisiko zur Verfügung stehen, zu beschreiben und Empfehlungen zur Klassifizierung von Patientinnen gemäß ihrem Rezidivrisiko aufzustellen. Es wurden auch nationale und internationale Behandlungsrichtlinien zusammengefasst. Die korrekte Einschätzung des Rezidivrisikos ist für diese Patientinnen wichtig, weil das prognostizierte Risiko die nachfolgenden Therapieentscheidungen steuern wird; unpräzise Einschätzungen können zur Über- bzw. Untertherapie führen, und beide Szenarien haben negative Konsequenzen für Patientinnen. Es gibt zahlreiche prognostische Werkzeuge und Faktoren, die für die Analyse von Brustkrebs im Frühstadium empfohlen werden; es gibt aber keinen Test, der für sich genommen eine akkurate Prognose bieten kann. Da es keinen Test gibt, der für sich allein genommen imstande ist, eine akkurate Prognose zu bieten, sollte eine Kombination verschiedener Testverfahren verwendet werden. Risikoschwellen sind wichtig, da diese die Entscheidung für eine optimierte, ausgewogene Therapie bei HR+, HER2− frühem Mammakarzinom lenkt. Dennoch sollte jede prognostische Evaluierung individuell durchgeführt werden, da ein patientenspezifisches prognostisches Vorgehen wichtig ist, um eine Über- oder Untertherapie zu vermeiden.
Publikationsverlauf
Eingereicht: 15. Dezember 2023
Angenommen nach Revision: 23. Dezember 2023
Artikel online veröffentlicht:
08. Februar 2024
© 2024. The Author(s). This is an open access article published by Thieme 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 commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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