State of the Art der endokrinen Therapie des metastasierten Mammakarzinoms

According to current knowledge metastatic breast cancer (MBC) is an incurable disease. Therefore, the focus of treatment is on improving quality of life and palliating symptoms besides prolonging survival. Endocrine therapy is the modality of choice for all ER- or PR-positive patients not requiring chemotherapy for rapidly progressive disease with massive symptoms. Aromatase inhibitors are the first choice in MBC for tamoxifen-naïve patients as well as for patients who have received adjuvant tamoxifen. Steroidal and nonsteroidal aromatase inhibitors can be used sequentially. The next step for the tamoxifen-naïve patient would be tamoxifen. Based on new data the antiestrogen fulvestrant is the next step in this algorithm, followed by the progestins. In the premenopausal situation a benefit from the combination of LHRH analogues and tamoxifen has been shown. Further therapy steps are extrapolated from the postmenopausal situation always in combination with ovarian suppression.