Chemoendokrine Therapie des Mammakarzinoms bei prämenopausalen Patientinnen

Abstract

Ovarian ablation has been used for a long period of time as an effective method in breast cancer treatment. The effectiveness of this therapy has been proven by multiple trials which by now provide long-time results. Currently available endocrine therapies either lower estrogen production or modulate estrogen receptor (ER) activity or regulate the expression of the ER. The efficacy of chemotherapy is partly related to the induction of secondary amenorrhea in premenopausal women by cytotoxic agents. A comparison of current standard chemotherapies with endocrine therapies shows that ovarian suppression and chemotherapy are equieffective in premenopausal women with hormone-sensitive breast cancer. Ovarian ablation increases long-lasting survival in breast cancer patients younger than 50 years of age, at least in the absence of chemotherapy. In premenopausal women with hormone-sensitive breast cancer ovarian suppression with gosereline with or without tamoxifen seems to be at least as effective as CMF chemotherapy alone. There are data which indicate a superiority of gosereline plus tamoxifen to gosereline monotherapy, at least if chemotherapy has been applied as well. Sequential use of gosereline after CMF chemotherapy seems to be superior to any modality alone in node-negative patients, at least in women younger than 40 years of age with hormone-sensitive tumors. Monochemotherapy alone is not sufficient in patients younger than 35 years of age with hormone-sensitive tumors. On the basis of the available data a final answer to the use of combined chemoendocrine therapy cannot be given as yet.