Zusammenfassung
Die prognostische Relevanz isolierter Tumorzellen im Knochenmark ist bei Brustkrebspatientinnen sowohl zum Zeitpunkt der Diagnosestellung als auch im rezidivfreien Intervall durch zahlreiche Studien belegt. Neuere Untersuchungen belegen, dass auch das Auftreten zirkulierender Tumorzellen im Blut mit einem erhöhten Rezidivrisiko und einem verkürzten Überleben nach einer Bruskrebserkrankung assoziiert ist. Isolierte Tumorzellen sind auch viele Jahre nach Erstdiagnose nachweisbar. In der Umgebung des Knochenmarks verharren sie über lange Zeit im Ruhezustand, können dann aber Ausgangspunkt von Rezidiven werden. Sowohl die Ruhephase als auch die Reaktivierung werden durch ein komplexes Zusammenspiel der Tumorzellen mit den Zellen des umgebenden Gewebes reguliert, die eine schützende Nische für die Tumorzelle bilden können. Ein besseres Verständnis dieses Zusammenspiels kann die Grundlage für zukünftige effektive Therapieansätze bilden, die gleichzeitig an der Tumorzelle und ihrer Umgebung ansetzen. Labortechnische Verfahren ermöglichen zudem eine Phänotypisierung der isolierten Tumorzellen, sodass sie als direkter Angriffspunkt für moderne zielgerichtete Substanzen genutzt werden können. Laufende Studien (DETECT III, TREAT CTC) untersuchen derzeit individualisierte Therapieansätze gegen zirkulierende Tumorzellen im Blut.
Abstract
Numerous studies have shown the prognostic relevance of isolated tumor cells in the bone marrow of breast cancer patients, both at primary diagnosis and during recurrence-free follow-up. Recent publications also suggest that circulating tumor cells in peripheral blood are associated with an increased risk of recurrence and shorter survival. These dormant cells can be detected in the bone marrow many years after the primary diagnosis, and can be the source of late metastases. Both the dormancy and the reactivation of these cells are regulated by a complex interaction between the tumor cells and the surrounding tissue, which forms a protecting premetastatic niche for the tumor cell. A better understanding of these interactions can be the basis for future treatment approaches, combining therapies directed against both the tumor cell and the microenvironment. Additionally, phenoty** of the isolated tumor cells can disclose tumor cell characteristics that can be directly tackled by modern targeted agents. Several recruiting trials (DETECT III, TREAT CTC) are underway to evaluate whether the prognosis of patients can be improved by individualized treatment approaches directed against circulating tumor cells in the blood.
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Rack, B., Müller, V., Fehm, T. et al. Knochen als Rückzugsort für „dormant cells“. Gynäkologe 46, 250–254 (2013). https://doi.org/10.1007/s00129-012-3090-x
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DOI: https://doi.org/10.1007/s00129-012-3090-x