Breast Cancer Update 2014 – Focus on the Patient and the Tumour

Abstract

The therapy for patients with breast cancer has developed markedly in the past ten years. Our understanding of the molecular biology of tumours and the characteristics of the patients has shaped the recent advances. In this review we present the latest knowledge about the therapy for breast cancer. There are new tests and options not only in the field of anti-HER2 therapy but also in the management of triple negative and hormone receptor-positive patients. Comprehension of prognosis and therapeutic response to chemotherapies is little by little helping to define patient groups who will not respond to chemotherapy or who do not need treatment because their prognosis is extremely good. In the field of anti-HER2 therapy, work is continuing on the development of drugs suitable for and able to overcome trastuzumab resistance. For hormone receptor-positive cancers, we now have a better understanding of which therapy groups will benefit from which anti-endocrine drugs, and which will be able to overcome a possible resistance (treatment of the PI3K pathways, inhibition of the cell cycle). Molecular tests are still being evaluated with regard to the clinical situations in which they may have the greatest relevance for therapeutic decision-making; however, evidence is also increasing as to the fields in which good predictions for the prognosis can be obtained. On the whole, more work is needed to promote our understanding of the new developments in diagnostics and therapy and to involve both physicians and patients equally in the procedures.

Zusammenfassung

Die Therapie von Patientinnen mit Mammakarzinom hat sich in den letzten 10 Jahren deutlich weiterentwickelt. Das Verständnis um die molekulare Biologie der Tumoren und Patientinneneigenschaften haben die jüngsten Entwicklungen geprägt. In diesem Review werden die neuesten Erkenntnisse zur Therapie des Mammakarzinoms dargestellt. Hierbei gibt es sowohl auf dem Gebiet der Anti-HER2-Therapie als auch bei der Behandlung von triple-negativen und hormonrezeptorpositiven Patientinnen neue Tests und Therapien. Das Verständnis um Prognose und Therapieansprechen auf Chemotherapien definiert nach und nach Patientinnengruppen, die nicht auf eine Chemotherapie ansprechen oder die keine Therapie benötigen, weil die Prognose außerordentlich gut ist. Auf dem Gebiet der Anti-HER2-Therapie wird weiterhin an Medikamenten gearbeitet, die bei einer Trastuzumab-Resistenz geeignet sind, diese zu überwinden. Für hormonrezeptorpositive Karzinome wird besser verstanden, welche Therapiegruppen von welchen antiendokrinen Medikamenten profitieren, und welche eine eventuelle Resistenz überwinden können (Behandlung des PI3K-Pathways, Inhibition des Zellzyklus). Molekulare Tests befinden sich weiterhin in der Evaluation, in welchen klinischen Situationen sie den größten Nutzen für Therapieentscheidungen bringen können, jedoch wächst die Evidenz, in welchen Bereichen eine gute Aussage über die Prognose gewonnen werden kann. Insgesamt muss daran gearbeitet werden, das Verständnis für die neuen Entwicklungen in Diagnostik und Therapie zu fördern und Ärzte und Patientinnen gleichermaßen in die Ausbildung mit einzubeziehen.

Key words

breast cancer - chemotherapy - hormonal therapy

Schlüsselwörter

Mammakarzinom - Chemotherapie - Hormontherapie

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