Zusammenfassung
Die Ziele palliativer Behandlungsmaßnahmen sind eine Besserung tumorbedingter Beschwerden, der Erhalt der körperlichen Leistungsfähigkeit und der Lebensqualität und eine Verlängerung der Überlebenszeit. Aufgrund der unterschiedlichen Krankheitsverläufe sollte die Behandlungsführung individuell angepasst werden. Endokrine Therapien oder Monochemotherapien kommen vor allem für Frauen in Betracht, die sich in einer günstigen oder intermediären prognostischen Situation befinden und eine langsame Progression des Tumorgeschehens bzw. geringe tumorbedingte Beschwerden aufweisen. Für Patientinnen mit ungünstiger Prognose oder ausgeprägten tumorbedingten Beschwerden erscheinen hingegen eher Polychemotherapien indiziert. Die Anthrazykline sind eine der wirksamsten Substanzgruppen und behalten auch nach adjuvanter Anthrazyklin-Vorbehandlung eine hohe Effektivität bei. Zur Verringerung der Kardiotoxizität kann eine Verlängerung der Infusionsdauer, eine wöchentliche Fraktionierung oder der Einsatz liposomaler Präparate erfolgen. Taxane weisen keine vollständige Kreuzresistenz zu Anthrazyklinen auf und können sowohl in wöchentlichen oder dreiwöchentlichen Intervallen verabreicht werden. Nach Versagen von Anthrazyklinen und Taxanen können Capecitabin, Vinorelbin oder Gemcitabin zum Teil noch zu objektiven Remissionen oder einer vorübergehenden Krankheitsstabilisierung führen. Die Entscheidung über die Dauer der zytostatischen Therapiemaßnahmen muss individuell gemeinsam mit der Patientin festgelegt werden.
Abstract
Primary goals of treatment in metastatic breast cancer include prevention and palliation of symptoms, maintenance or improvement of quality of life and prolongation of survival. In order to account for the variability of clinical courses, treatment decisions have to be made on an individual basis. Low risk patients without evidence of rapid disease progression or symptomatic disease are mainly considered for endocrine treatment or single agent chemotherapy, whereas patients at higher risk with rapidly progressive or symptomatic disease are candidates for polychemotherapies. Anthracyclines are one of the most active group of agents and remain active after adjuvant pre-treatment. The use of liposomal derivatives or weekly or prolonged application can decrease the risk of cardiotoxicity. There is only incomplete cross-resistance between anthracyclines and taxanes. Taxane-based weekly or 3weekly regimens are therefore generally used in anthracycline-pretreated patients. Capecitabine, gemcitabine, or vinorelbine constitute candidate agents after failure of anthracyclines and/or taxanes and may result in objective responses or disease stabilisation. Data on the continuation beyond third-line chemotherapy are insufficient. Decisions have therefore to be made on an individual basis.
Schlüsselwörter
Metastasiertes Mammakarzinom - palliative Therapie - Chemotherapie - Anthrazykline - Taxane - Capecitabin - Vinorelbin
Key words
metastatic breast cancer - palliation - chemotherapy - anthracyclines - taxanes - capecitabine - vinorelbin
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Dr. P. Schmid , Consultant Medical Oncologist & Senior Clinical Lecturer · Director Early Clinical Trials Unit
Charing Cross and Hammersmith Hospital · Imperial College London
Fulham Palace Road
London, W6 8RF
United Kingdom
Telefon: +44/20/88 46 14 18
eMail: p.schmid@imperial.ac.uk
