Tumor- und risikoadaptierte Individualisierung der neoadjuvanten und post-neoadjuvanten Therapie bei PatientInnen mit Mammakarzinom

During the last decade, modern oncology has switched from a “one therapy fits all” to a risk-tailored and individualized medicine. For breast cancer, the most common malignancy in women worldwide, this has led to early breast cancer nowadays being seen as a curable disease. A great benefit of modern diagnostic options and targeted therapies is the differ-entiation between breast cancer patients at different disease-related risk situations, e.g. regarding recurrence. This differentiation is mainly based on worldwide used classification systems, like the TNM-classification, grading, as well as surrogate-subtyping based on the immunohistological profile of the primary disease. The advancement towards personalized, risk-tailored oncologic therapy will surely continue due to the development of. targeted ther-apies and the specific identification of patients with an increased tumor-associated risk. The aim of this thesis was on the one hand to identify patients with a high chance for a pathologic complete response with in vivo evaluation of therapeutic response and therefore a high chance for a favorable prognosis. On the other hand, there is a major need to identi-fy patients at increased oncologic risk, even though they receive state-of-the-art systemic therapy. Tumors may develop therapeutic resistance or change biological characteristics, leading to a progredient oncologic disease. These patients are therefore in need of a switch of the systemic therapy, regularly leading to therapeutic escalation. With the publication The use of breast ultrasound for prediction of pathologic complete response in different subtypes of early breast cancer within the WSG-ADAPT subtrials (2) we were able to show that especially for patients with HR-negative/HER2-negative or HR-negative/HER2-positive early breast cancer, ultrasound allows the prediction of pathological complete response is statistically reliable for approximately 2/3 of patients (65 % and 69 % respectively) as early as three weeks into neoadjuvant therapy. This may ...