Was ist neu in der systemischen Behandlung des frühen Mammakarzinoms?

In 2022, breast cancer was still the leading malignancy in women worldwide, with 2.3 million new cases and 665,000 patients dying from the disease. Primary breast cancer can be cured in most cases by multimodal therapy consisting of systemic and operative treatment, complemented by adjuvant radiotherapy if necessary. Cure rates depend on clinical stage and subtype. According to molecular tumor biology, four prognostically and therapeutically relevant subgroups have been established based on the determination of histopathological steroid hormone and HER2 receptor staining correlates: the luminal A‑like hormone receptor-positive early breast cancer, which is characterized by a low rate of recurrences and therefore needs no chemotherapy, but does need endocrine, surgical and radiotherapeutic treatment; the luminal B‑like hormone receptor-positive early breast cancer, which, due to its aggressive biology, needs all treatment options mentioned; the HER2-positive type, which is also treated by all therapeutic options plus targeted anti-HER2 treatment; in triple-negative breast cancer, which lacks any therapeutic target, chemotherapy complemented by surgery and radiotherapy is mandatory. In order to treat our patients with more success, new treatment concepts based on post-neoadjuvant add-on strategies in high-risk patients and the omission of treatment through neoadjuvant induction concepts have been tested. Therefore, new substances such as CDK4/6 and PARP inhibitors, immunotherapy and antibody drug conjugates are added to standard treatments and are introduced into clinical practice for the treatment of early breast cancer.