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. 2021 May;81(5):526-538.
doi: 10.1055/a-1464-0953. Epub 2021 May 3.

Update Breast Cancer 2021 Part 1 - Prevention and Early Stages

Affiliations

Update Breast Cancer 2021 Part 1 - Prevention and Early Stages

Elmar Stickeler et al. Geburtshilfe Frauenheilkd. 2021 May.

Abstract

This review summarises not only the latest evidence on prevention, but also the current research on the treatment of early-stage breast cancer patients. Recent years have seen a growing body of evidence on the risk of high- and moderate-penetrance breast cancer susceptibility genes. A large international consortium has now been able to further refine the answer to the question of the significance of the so-called panel genes. Moreover, the data on treatment selection regarding endocrine efficacy and the decision for or against chemotherapy have also been advanced markedly. There is also new data on adjuvant CDK4/6 (cyclin-dependent kinase 4/6) inhibitors, which are standard in first-line treatment in patients with metastatic HER2-negative, hormone receptor-positive (HR+) breast cancer. For other therapies such as immune checkpoint inhibitors, which have successfully improved the rate of pathologic complete response (pCR) in neoadjuvant treatment settings for patients with triple-negative breast cancer (TNBC), there is a growing understanding of the quality of life and side effects. This is especially important in situations where patients could possibly be cured without such a regimen.

Keywords: digital medicine; early breast cancer; immunotherapy; prevention; prognosis; treatment.

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Conflict of interest statement

Conflict of Interest/Interessenkonflikt E. S. received honoraria from Roche, Celgene, AstraZeneca, Novartis, Pfizer, Tesaro, Aurikamed GmbH, MCI Deutschland GmbH, bsh medical communications GmbH, Onkowissen TV. B. A. received honoraria from AstraZeneca, Genomic Health, Roche, Novartis, Celgene, Lilly, MSD, Eisai, Teva, Tesaro, Daiichi-Sankyo and Pfizer. E. B. received honoraria from Novartis, Hexal, BMS, Lilly, Pfizer, Roche, MSD, Bayer, Ipsen, Bluebird, BBraun and onkowissen.de for consulting, clinical research management or medical education activities. N. D. has received honoraria from MSD, Roche, AstraZeneca, Teva, Mentor and MCI Healthcare. P. A. F. received honoraria from Novartis, Pfizer, Roche, Amgen, Celgene, Daiichi-Sankyo, onkowissen.de, AstraZeneca, Merck-Sharp & Dohme, Eisai, Puma and Teva. His institution conducts research with funding from Novartis and Biontech. T. N. F. has participated on advisory boards for Amgen, Daiichi Sankyo, Novartis, Pfizer, and Roche and has received honoraria for lectures from Amgen, Celgene, Daiichi Sankyo, Roche, Novartis and Pfizer. A. D. H. received speaker and consultancy honoraria from AstraZeneca, Genomic Health, Roche, Novartis, Celgene, Lilly, MSD, Eisai, Teva, Tesaro, Daiichi-Sankyo, Hexal and Pfizer. C. J. reports personal fees from AstraZeneca, Exact Sciences, Lilly, Novartis and Roche during the conduct of the study. W. J. has received research Grants and/or honoraria from Sanofi-Aventis, Daiichi-Sankyo, Novartis, Roche, Pfizer, Lilly, AstraZeneca, Chugai, GSK, Eisai, Cellgene and Johnson&Johnson. C. K.-L. has received honoraria from Roche, AstraZeneca, Celgene, Novartis, Pfizer, Lilly, Hexal, Amgen, Eisai, and SonoScape, honoraria for consultancy from Phaon Scientific, Novartis, Pfizer, and Celgene, research funding from Roche, Novartis, and Pfizer, and travel grants from Novartis and Roche. H.-C. K. has received honoraria from Pfizer, Novartis, Roche, Genomic Health/Exact Sciences, Amgen, AstraZeneca, Riemser, Carl Zeiss Meditec, Teva, Theraclion, Janssen-Cilag, GSK, LIV Pharma, Lily, SurgVision, Onkowissen and MSD, travel support from Carl Zeiss Meditec, LIV Pharma, Novartis, Amgen, Pfizer, Daiichi Sankyo, Tesaro and owns stock of Theraclion SA and Phaon Scientific GmbH. D. L. received honoraria from Amgen, AstraZeneca, Celgene, Lilly, Loreal, MSD, Novartis, Pfizer, Tesaro, Teva. M. P. L. has participated on advisory boards for AstraZeneca, Lilly, MSD, Novartis, Pfizer, Eisai, Exact Sciences and Roche and has received honoraria for lectures from MSD, Lilly, Roche, Novartis, Pfizer, Exact Sciences, AstraZeneca, medac and Eisai. V. M. received speaker honoraria from Amgen, Astra Zeneca, Daiichi-Sankyo, Eisai, Pfizer, MSD, Novartis, Roche, Teva, Seattle Genetics and consultancy honoraria from Genomic Health, Hexal, Roche, Pierre Fabre, Amgen, ClinSol, Novartis, MSD, Daiichi-Sankyo, Eisai, Lilly, Tesaro, Seattle Genetics and Nektar. Institutional research support from Novartis, Roche, Seattle Genetics, Genentech. Travel grants: Roche, Pfizer, Daiichi Sankyo. M. S. has previously received honoraria for advisory board duty from Roche, Pfizer, Novartis, Astra-Zeneca and Eisai. A. S. received honoraria from Roche, Celgene, AstraZeneca, Novartis, Pfizer, Zuckschwerdt Verlag GmbH, Georg Thieme Verlag, Aurikamed GmbH, MCI Deutschland GmbH, bsh medical communications GmbH and promedicis GmbH. F. S. participated on advisory boards for Novartis, Lilly, Amgen and Roche and received honoraria for lectures from Roche, AstraZeneca, MSD, Novartis and Pfizer. H. T. received honoraria from Novartis, Roche, Celgene, Teva, Pfizer, Astra Zeneca and travel support from Roche, Celgene and Pfizer. C. T. Advisory boards, lectures: Amgen, AstraZeneca, Celgen, Daiichi-Sankyo, Eisai, Lilly, MSD, Mundipharma, Medapharm, Novartis, Pfizer, Pierre-Fabre, Roche, Tesaro, and Vifor. C. U. received honoraria from Roche, Novartis, Pfizer, Astra-Zeneca, MSD and onkowissen.de. M. U. all honoraria went to the institution/employer: Abbvie, Amgen, Astra Zeneca, Celgene, Daichi Sankyo, Eisai, Lilly, MSD Merck, Mundipharma, Myriad Genetics, Pfizer, PUMA Biotechnology, Roche, Sanofi Aventis, Novartis, Pierre Fabre. M. W. has participated on advisory boards for AstraZeneca, Lilly, MSD, Novartis, Pfizer and Roche. A. W. participated on advisory boards for Novartis, Lilly, Amgen, Pfizer, Roche, Tesaro, Eisai and received honoraria for lectures from Novartis, Pfizer, Aurikamed, Roche, Celgene. R. W. has received personal fees/travel support from Agendia, Amgen, Aristo, Astra Zeneca, Boehringer Ingelheim, Carl Zeiss, Celgene, Clinsol, Daiichi-Sankyo, Eisai, Exact Sciences, Genomic Health, Glaxo Smith Kline, Hexal, Lilly, Medstrom Medical, MSD, Mundipharma, Nanostring, Novartis, Odonate, Paxman, Palleos, Pfizer, Pierre Fabre, Puma Biotechnology, Riemser, Roche, Sandoz/Hexal, Seattle Genetics, Tesaro Bio, Teva, Veracyte and Viatris. M. T. has participated on advisory boards for AstraZeneca, ClearCut, Clovis, Daiichi Sankyo, Eisai, Exact Sciences, GSK, Lilly, MSD, Neodynamics, Novartis, Pfizer, pfm medical, Pierre-Fabre, Roche and Sysmex and has received honoraria for lectures from Amgen, AstraZeneca, Clovis, Daiichi Sankyo, Eisai, Hexal, GSK, Lilly, MSD, Roche, Novartis, Pfizer, Exact Sciences and pfm medical and has received trial funding by Exact Sciences and Endomag. The other authors have no conflict of interest to declare for this specific work./ E. S. erhielt Honorare von Roche, Celgene, AstraZeneca, Novartis, Pfizer, Tesaro, Aurikamed GmbH, MCI Deutschland GmbH, bsh medical communications GmbH, Onkowissen TV. B. A. erhielt Honorare von AstraZeneca, Genomic Health, Roche, Novartis, Celgene, Lilly, MSD, Eisai, Teva, Tesaro, Daiichi-Sankyo und Pfizer. E. B. erhielt Honorare von Novartis, Hexal, BMS, Lilly, Pfizer, Roche, MSD, Bayer, Ipsen, Bluebird, BBraun und onkowissen.de für Beratung, klinisches Forschungsmanagement bzw. medizinische Fortbildungsaktivitäten. N. D. erhielt Honorare von MSD, Roche, AstraZeneca, Teva, Mentor und MCI Healthcare. P. A. F. erhielt Honorare von Novartis, Pfizer, Roche, Amgen, Celgene, Daiichi-Sankyo, onkowissen.de, AstraZeneca, Merck-Sharp & Dohme, Eisai, Puma und Teva. Sein Institut forscht mit finanzieller Unterstützung von Novartis und Biontech. T. N. F. war für Amgen, Daiichi Sankyo, Novartis, Pfizer und Roche in Beratungsgremien tätig und erhielt für Vortragstätigkeit Honorare von Amgen, Celgene, Daiichi Sankyo, Roche, Novartis und Pfizer. A. D. H. erhielt für Vortrags- und Beratertätigkeiten Honorare von AstraZeneca, Genomic Health, Roche, Novartis, Celgene, Lilly, MSD, Eisai, Teva, Tesaro, Daiichi-Sankyo, Hexal und Pfizer. C. J. gibt persönliche Honorare von AstraZeneca, Exact Sciences, Lilly, Novartis und Roche während der Durchführung der Studie an. W.J . hat Forschungszuschüsse und/oder Honorare von Sanofi-Aventis, Daiichi-Sankyo, Novartis, Roche, Pfizer, Lilly, AstraZeneca, Chugai, GSK, Eisai, Celgene und Johnson&Johnson erhalten. C. K.-L. erhielt Honorare von Roche, AstraZeneca, Celgene, Novartis, Pfizer, Lilly, Hexal, Amgen, Eisai und SonoScape, Honorare für Beratungstätigkeit von Phaon Scientific, Novartis, Pfizer und Celgene, Forschungsgelder von Roche, Novartis und Pfizer sowie Reisekostenzuschüsse von Novartis und Roche. H.-C. K. hat Honorare von Pfizer, Novartis, Roche, Genomic Health/Exact Sciences, Amgen, AstraZeneca, Riemser, Carl Zeiss Meditec, Teva, Theraclion, Janssen-Cilag, GSK, LIV Pharma, Lily, SurgVision, Onkowissen und MSD erhalten, Reiseunterstützung von Carl Zeiss Meditec, LIV Pharma, Novartis, Amgen, Pfizer, Daiichi Sankyo, Tesaro und besitzt Aktien von Theraclion SA und Phaon Scientific GmbH. D. L. erhielt Honorare von Amgen, AstraZeneca, Celgene, Lilly, Loreal, MSD, Novartis, Pfizer, Tesaro und Teva. M. P. L. war in Beiräten für AstraZeneca, Lilly, MSD, Novartis, Pfizer, Eisai, Exact Sciences und Roche tätig und erhielt Honorare für Vortragstätigkeit von MSD, Lilly, Roche, Novartis, Pfizer, Exact Sciences, AstraZeneca, medac und Eisai. V. M. erhielt Honorare für Vortragstätigkeit von Amgen, AstraZeneca, Daiichi-Sankyo, Eisai, Pfizer, MSD, Novartis, Roche, Teva, Seattle Genetics und Honorare für Beratungstätigkeit von Genomic Health, Hexal, Roche, Pierre Fabre, Amgen, ClinSol, Novartis, MSD, Daiichi-Sankyo, Eisai, Lilly, Tesaro, Seattle Genetics und Nektar. Institutionelle Forschungsunterstützung von Novartis, Roche, Seattle Genetics, Genentech. Reisekostenzuschüsse: Roche, Pfizer, Daiichi Sankyo. M. S. hat zuvor Honorare für Beiratstätigkeit von Roche, Pfizer, Novartis, AstraZeneca und Eisai erhalten. A. S. erhielt Honorare von Roche, Celgene, AstraZeneca, Novartis, Pfizer, Zuckschwerdt Verlag GmbH, Georg Thieme Verlag, Aurikamed GmbH, MCI Deutschland GmbH, bsh medical communications GmbH und promedicis GmbH. F. S. war in Beiräten für Novartis, Lilly, Amgen und Roche tätig und erhielt Honorare für Vortragstätigkeit von Roche, AstraZeneca, MSD, Novartis und Pfizer. H. T. erhielt Honorare von Novartis, Roche, Celgene, Teva, Pfizer, AstraZeneca und Reisekostenunterstützung von Roche, Celgene und Pfizer. C. T. Beiräte, Vorträge: Amgen, AstraZeneca, Celgene, Daiichi-Sankyo, Eisai, Lilly, MSD, Mundipharma, Medapharm, Novartis, Pfizer, Pierre-Fabre, Roche, Tesaro und Vifor. C. U. erhielt Honorare von Roche, Novartis, Pfizer, AstraZeneca, MSD und onkowissen.de. M. U. alle Honorare gingen an die Einrichtung/den Arbeitgeber: AbbVie, Amgen, AstraZeneca, Celgene, Daichi-Sankyo, Eisai, Lilly, MSD Merck, Mundipharma, Myriad Genetics, Pfizer, Puma Biotechnology, Roche, Sanofi Aventis, Novartis, Pierre Fabre. M. W. hat in Beiräten für AstraZeneca, Lilly, MSD, Novartis, Pfizer und Roche mitgewirkt. A. W. war in Beiräten für Novartis, Lilly, Amgen, Pfizer, Roche, Tesaro, Eisai tätig und erhielt Honorare für Vortragstätigkeit von Novartis, Pfizer, Aurikamed, Roche, Celgene. R. W. hat persönliche Honorare/Reiseunterstützung erhalten von Agendia, Amgen, Aristo, AstraZeneca, Boehringer Ingelheim, Carl Zeiss, Celgene, Clinsol, Daiichi-Sankyo, Eisai, Exact Sciences, Genomic Health, Glaxo Smith Kline, Hexal, Lilly, Medstrom Medical, MSD, Mundipharma, Nanostring, Novartis, Odonate, Paxman, Palleos, Pfizer, Pierre Fabre, Puma Biotechnology, Riemser, Roche, Sandoz/Hexal, Seattle Genetics, Tesaro Bio, Teva, Veracyte und Viatris. M. T. war in Beiräten von AstraZeneca, ClearCut, Clovis, Daiichi-Sankyo, Eisai, Exact Sciences, GSK, Lilly, MSD, Neodynamics, Novartis, Pfizer, pfm medical, Pierre-Fabre, Roche und Sysmex tätig und hat von Amgen, AstraZeneca, Clovis, Daiichi Sankyo, Eisai, Hexal, GSK, Lilly, MSD, Roche, Novartis, Pfizer, Exact Sciences und pfm medical Honorare für Vortragstätigkeit sowie Studienfinanzierung von Exact Sciences und Endomag erhalten. Die anderen Autoren geben keinen Interessenkonflikt für diese konkrete Arbeit an.

Figures

Fig. 1
Fig. 1
Lifetime risk up to 80 years of age for the eight confirmed risk genes according to .
Fig. 2
Fig. 2
Kaplan-Meier estimator for event-free survival in the KEYNOTE-522 trial at the third interim analysis (from 63 ).
Fig. 3
Fig. 3
Change in health-related quality of life (EORTC-QLQC30) .
Fig. 4
Fig. 4
Change in fatigue subscore (EORTC-QLQC30) .
Fig. 5
Fig. 5
DEfenseCOVID-19 – Registration process and study workflow.
Abb. 1
Abb. 1
Lebenszeitrisiken bis zum 80. Lebensjahr für die 8 bestätigten Risikogene nach .
Abb. 2
Abb. 2
Kaplan-Meier-Schätzer für Event-Free Survival in der KEYNOTE-522-Studie bei der 3. Interimsanalyse (nach 63 ).
Abb. 3
Abb. 3
Veränderung der gesundheitsbezogenen Lebensqualität (Health related Quality of Life, EORTC-QLQC30) .
Abb. 4
Abb. 4
Veränderung des Fatigue Subscores (EORTC-QLQC30) .
Abb. 5
Abb. 5
DEfenseCOVID-19 – Registrierungsprozess und Studienablauf.

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