Brustkrebs gehört in Deutschland zu den häufigsten Krebserkrankungen bei Frauen. Ungefähr 70.000 sind im Jahr 2018 neu erkrankt. Das sind etwa 30 Prozent der Krebsneuerkrankungen insgesamt. Doch bei einer frühzeitigen Erkennung besteht mit 95 Prozent eine sehr hohe Heilungschance. Zur Früherkennung wurden bis jetzt das Mammographie-Screening, MRT, die Tast- und Selbstuntersuchung der Brust sowie Ultraschall eingesetzt. Forscher des Universitäts-Frauenklinikums Heidelberg stellten heute ein neues Verfahren in der Brustkrebsdiagnostik vor: Mit Hilfe eines Bluttests soll diese deutlich verbessert werden.
„Der von unserem Forscherteam entwickelte Bluttest ist eine neue, revolutionäre Möglichkeit, eine Krebserkrankung in der Brust nicht-invasiv und schnell anhand von Biomarkern im Blut zu erkennen“, so Prof. Dr. Christof Sohn, Geschäftsführender Ärztlicher Direktor der Heidelberger Uni-Klinik.
Prof. Dr. Sarah Schott, Sektionsleiterin Translationale Frauenheilkunde und Leiterin für Familiäre Krebserkrankungen der Klinik, verantwortete das Projekt gemeinsam mit Prof. Dr. Sohn. Sie ergänzt: „Das neue blutbasierte Verfahren ist deutlich weniger belastend für Frauen, weil es weder schmerzhaft ist noch mit einer Strahlenbelastung einhergeht.“
LIQUID BIOPSY
Denn auf Basis der sogenannten „Liquid Biopsy“ ist es nun möglich, die Erkrankung anhand von Biomarkern zu diagnostizieren. So können Informationen über eine Erkrankung aus Körperflüssigkeiten wie beispielsweise Blut, Urin oder Speichel gewonnen werden. Hierfür werden Botenstoffe von Tumorzellen in der Flüssigkeitsprobe untersucht. Für den aktuellen Test sind nur wenige Milliliter Blut notwendig. In diesem können von an Brustkrebs erkrankten Frauen 15 verschiedene Biomarker (miRNA und Methylierungsmarker) identifiziert werden. Mit deren Hilfe sind wiederum auch kleine Tumore nachweisbar. Die Durchführung des Tests ist in jedem Labor möglich. Er erweitert das Diagnosespektrum der bislang durchgeführten, optischen Verfahren.
Durchführbar ist der Test bei Frauen aller Altersgruppen. Doch besonders profitieren jüngere Frauen unter 50 Jahren davon. Aber auch für Frauen mit familiärer Hochrisikosituation für eine Brustkrebserkrankung, bei denen eine Mammografie beispielsweise aufgrund des dichten Brustdrüsengewebes wenig Aussage liefert oder aufgrund anderer Risikofaktoren herkömmliche bildgebende Verfahren kontraindiziert sind, ist er eine gute Alternative. Hier konnte eine Sensitivität von 80 bis 90 Prozent erreicht werden. Die Sensitivität gibt an, zu welchem Prozentsatz erkrankte Patientinnen durch den Test tatsächlich erkannt werden.
DIAGNOSE VON WEITEREN KREBSARTEN WIRD ERFORSCHT
Das Universitätsklinikum Heidelberg gilt als eines der bedeutendsten medizinischen Zentren in Deutschland. Insbesondere ist es auch für seine Krebsforschung und -therapie bekannt. Schon seit Jahren wird am Klinikum im Bereich Liquid Biopsy geforscht. Im Jahr 2016 meldeten die Wissenschaftler das dem Test zugrunde liegende Verfahren als Patent an. So wurden erste Fördermittel gewonnen. Seitdem arbeiteten die Forscher daran das Verfahren zu verfestigen und weiterzuentwickeln sowie die Genauigkeit in diversen Untersuchungen zu bestätigen.
Untersucht wurde in den letzten 12 Monaten eine Kohorte von über 900 Frauen mit über 500 Brustkrebspatientinnen und 400 gesunden Frauen. Die Studie ist auf eine Teilnehmerzahl von 2.000 ausgelegt und wird als Multizenterstudie fortgeführt. Aktuelle Ergebnisse zeigen bei den 500 Brustkrebspatientinnen insgesamt eine Sensitivität von 75 Prozent. Wobei hier altersabhängige Unterschiede festgestellt wurden: bei den unter 50‑jährigen zeigte sich eine Sensitivität von 86 Prozent bzw. bei den über 50-jährigen von 60 Prozent.
Ziel der fortlaufenden Studie ist es, die Aussagekraft, Sensitivität und Einsatzmöglichkeit durch zukünftige Analysen weiter zu spezifizieren und zu verbessern. Auch wird der Einsatz bei weiteren Krebsarten, so z. B. Eierstockkrebs, erforscht. Die derzeitigen Zwischenergebnisse erreichen eine Sensitivität von bis zu 80 Prozent bei den rund 200 untersuchten Patientinnen.
PERSONALISIERTE CHEMOTHERAPIE MÖGLICH
Neben der Erkennung einer Krebserkrankung kann der Bluttest zur Analyse weiterer Daten dienen. So soll zukünftig anhand von Biomarkern auch eine Metastasenbildung oder ein Rezidiv frühzeitiger erkannt werden. Auch soll der Test bei der Langzeitüberwachung eingesetzt werden. Daneben dienen die gewonnenen Informationen auch der Therapie: Die Biomarker können Auskunft darüber geben, ob eine Behandlung anspricht oder eine Therapieresistenz eintritt. Die ersten Erkenntnisse deuten darauf hin, dass das individuelle Ansprechen auf eine Chemotherapie über Liquid Biopsy überwacht werden kann und so eine langfristig personalisiertere Chemotherapiebehandlung möglich wird.
Um die notwendigen Zertifizierungen voranzutreiben und die Marktreife sicherzustellen, gründeten die Wissenschaftler nun eine Gesellschaft mit dem Namen HeiScreen GmbH. Die Gesellschaft soll die Markteinführung des Verfahrens voranbringen und Vertriebskanäle entwickeln. Die CE-Zertifizierung hat bereits begonnen, um den Bluttest noch in diesem Jahr in die klinische Anwendung zu bringen.
Bild oben: Prof. Dr. Sarah Schott und Prof. Dr. Christof Sohn von der Universitäts-Frauenklinik ©Universitätsklinikum Heidelberg
Dieser Artikel erschien am 21.2.2019 in der Innovation Origins.
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