Deutsche Zeitschrift für Onkologie 2013; 45(04): 167-173
DOI: 10.1055/s-0030-1248355
© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Genomische Testverfahren für die individuelle Bestimmung des Rezidivrisikos beim frühen Mammakarzinom

Stefan Paepke
1   Interdisziplinäres Brustzentrum und Frauenklinik der Technischen Universität München, Roman Herzog Comprehensive Cancer Center
,
Johannes Ettl
1   Interdisziplinäres Brustzentrum und Frauenklinik der Technischen Universität München, Roman Herzog Comprehensive Cancer Center
,
Ralf Ohlinger
2   Brustzentrum der Frauenklinik, Ernst Moritz Arndt Universität, Greifswald
,
Janna Krol
1   Interdisziplinäres Brustzentrum und Frauenklinik der Technischen Universität München, Roman Herzog Comprehensive Cancer Center
,
Marion Kiechle
1   Interdisziplinäres Brustzentrum und Frauenklinik der Technischen Universität München, Roman Herzog Comprehensive Cancer Center
› Author Affiliations
Further Information

Publication History

Publication Date:
17 December 2013 (online)

Zusammenfassung

Tumorbiologische Faktoren determinieren im Wesentlichen die Therapieentscheidungen beim frühen Mammakarzinom. Problematisch ist jedoch die Therapieunsicherheit in der intermediären Risikogruppe, in der klassische Risikoklassifizierungen zu ungenau sind. Genomische Testverfahren schließen diese Lücke bei rezeptorpositiven, Her 2 neu negativen, nodal negativen oder gering nodal positiven Mammakarzinomen. In Deutschland stehen der 70-Gen-Assay Mamma-Print®, 21-Gen-Assay Oncotype DX® und der 8-Gen-Assay verknüpft mit klinisch-pathologischen Faktoren, EndoPredict®, zur Verfügung, die bei identischer Testmethodik unterschiedliche Proliferations- und Tumorbiologiegengruppen untersuchen. In der intermediären Risikogruppe werden durch die genomische Analyse nochmals Hoch- und Niedrigrisikocharakterisierungen vorgenommen und damit Therapieempfehlungen gestützt. Die bisherigen Anwendungen zeigen für alle Testverfahren einen Wechsel in den Therapieentscheidungen von ca. 30 % zu weniger Chemotherapie.

Trotz vielfältiger Anwendungen ist bisher eine Übernahme in die Regelversorgung nicht gewährleistet. Internationale und nationale Studien (Mindact, TailorX, RESCUE) werden prospektiv erhobene Daten zeigen und zu einer Verankerung in die Routinediagnostik führen.

Summary

Tumorbiologic factors largely determine therapy decisions in early breast cancer. However, in the intermediate risk group this remains problematic, for conventional risk classifications may be too imprecise. Genomic test arrays close this gap in receptor positive, HER2 negative, nodal negative or barely positive breast cancers. In Germany, the 70-gene array Mamma-Print®, 21-gene array Oncotype DX®, and the 8-gene array combined with clinical parameters, EndoPredict®, are available. Being methodically quite similar, these tests address different proliferation and tumorbiologic groups. In the intermediate risk group genomic tests help to differentiate between high and low risk groups and to support therapy decisions. Previous studies have shown for all assays a reduction of chemotherapy up to 30 %.

Despite numerous applications these tests are not incorporated in regular breast cancer care. International and national trials (Mindact, TailorX, RESCUE) will prosepctively collect data and help implementing these diagnostic tests in routine care.

 
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