TumorDiagnostik & Therapie 2004; 25(4): 151-159
DOI: 10.1055/s-2004-813041
Review

© Georg Thieme Verlag KG Stuttgart · New York

Chemotherapie des metastasierten kolorektalen Karzinoms

Chemotherapy of Metastatic Colorectal CancerG. Folprecht1 , C.-H Köhne1
  • 1University hospital „Carl Gustav Carus”, Medical Department I, Dresden
Further Information

Publication History

Publication Date:
23 August 2004 (online)

Zusammenfassung

Die Chemotherapie des metastasierten kolorektalen Karzinoms ist durch die Einführung von weiteren Medikamenten wesentlich verbessert worden: Kombinationen von Irinotecan oder Oxaliplatin mit einer 5-FU-Infusion und Folinsäure führen zu deutlich erhöhten Ansprechraten (um 50 %). Im Zusammenhang mit einer wirksamen Zweitlinientherapie liegt das mediane Überleben im metastasierten Stadium nun bei 20 Monaten und mehr. Durch die erhöhten Ansprechraten können bei primär nicht resektablen Lebermetastasen neoadjuvante Konzepte verfolgt werden. Durch die Überlebensverlängerung mit dieser Kombinationstherapie stellt sie - zumindest bei Patienten mit relativ gutem Allgemeinzustand - die Therapie der Wahl dar. 5-FU-prodrugs erlauben eine orale Therapie und damit eine für den Patienten bequemere Therapie. Zurzeit wird der Stellenwert einer Kombinationsbehandlung mit oralen Fluoropyrimidienen und Irinotecan oder Oxaliplatin geprüft. Neueste Studien zur Therapie des kolorektalen Karzinoms mit Antikörper zeigten viel versprechende Ergebnisse: Der VEGF-Antikörper Bevacizumab (in Kombination mit Chemotherapie) verlängert das Überleben um mehr als vier Monate verglichen mit alleiniger Chemotherapie. Der EGFR-Antikörper Cetuximab ist eine wirksame Therapie nach Progression unter Irinotecan.

Abstract

The introduction of new agents improved chemotherapy of metastatic colorectal cancer. A combination of infusional 5-FU/folinic acid with oxaliplatin or irinotecan results in markedly increased response rates (ca. 50 %). This effective first line therapy, together an effective second line therapy led to an median survival of 20 months and more. The increased response rates allow neoadjuvant treatment of primary non-resectable liver metastasis. Due to the survival benefit, combination first line therapy is the treatment of choice, at least in patients with good performance status. 5-FU prodrugs allow an oral therapy, which is more convenient to the patients. However, efficacy of this monotherapy is limited. Results of recently trials showed antibodies showed promising results: the VEGFR-antibody bevacizumab (in combination with chemotherapy) prolongs survival by more than 4 months compared to chemotherapy alone. The EGFR-antibody cetuximab is effective after progression during irinotecan-treatment.

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G. Folprecht

University hospital „Carl Gustav Carus”, Medical Department I

Fetscherstr. 74

01307 Dresden

Germany

Phone: +49-3 51/4 58 47 94

Fax: +49-3 51/4 58 58 87

Email: Gunnar.Folprecht@uniklinikum-dresden.de

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