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.
Schlüsselwörter
Kolorektale Karzinome - Chemotherapie
Key words
Colorectal cancer - chemotherapy
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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
