Zusammenfassung
Hintergrund: Es existiert eine Reihe von wirksamen Substanzen in der palliativen Behandlung kolorektaler
Karzinome. Dadurch gelang es, die medianen Überlebenszeiten deutlich zu verlängern
entweder rein medikamentös oder auch durch Erhöhung der sekundären Resektabilität
bei erhöhter Wirksamkeit der applizierten Medikamente. Patienten / Material: Entscheidend für den Therapieerfolg bleibt die Festlegung der Therapieart in Abhängigkeit
der vorherrschenden Patientencharateristik. Vorraussetzung ist hier eine interdisziplinäre
Abstimmung innerhalb von Tumorboards. Methoden: Bei aggressiver Tumorsymptomatik wird ein Therapieansatz mit Induktion einer hohen
Ansprechrate favorisiert. Dies beinhaltet in der Regel eine Drei- / Vierfach-Kombination
mit Antikörpern. Bei langsamem Tumorprogress und eingeschränktem Patientenprofil wird
eine sequenzielle Abfolge der Chemotherapie gewählt. Die Implementierung bzw. Einbindung
von lokal ablativen Therapieverfahren in die Behandlungskonzepte ist eine zusätzliche
Möglichkeit in der Effektivitätssteigerung. Im besten Falle können zusätzlich systemische
Nebenwirkungseffekte vermieden werden, was mit einem nicht unerheblichen Benefit für
die Lebensqualität einhergeht. Ergebnisse: Weitere Untersuchungen zur Genotypisierung neben dem K-RAS-Status sind notwendig,
um prädiktive und prognostische Aussagen bezüglich der eingesetzten Wirkstoffe zu
treffen und Wirkungslosigkeiten zu vermeiden. Schlussfolgerung: In der medikamentösen Therapie des metastasierten kolorektalen Karzinoms konnten
in den letzten Jahren gute Fortschritte erzielt werden. Der zielgerichtete Einsatz
der zur Verfügung stehenden sowie neueren Substanzen bedarf einer weiteren Evaluation
innerhalb von Studien.
Abstract
Background: There are a number of effective substances available for palliative treatment of
colorectal cancer, contributing to a considerable extension of the median survival
time either purely medically or by increasing the chance of secondary resectability
through improved effectiveness of the administered drugs. Patients / Material: Defining treatment depending on predominant patient characteristics remains crucial
for any therapeutic success. This requires interdisciplinary co-ordination within
tumour boards. Methods: In aggressive tumours a therapeutic approach inducing high response rates is favoured,
usually including a triple or quadruple combination incl. antibodies. In cases of
slow tumour progress and limited patient profile, a sequence of chemotherapy is chosen.
Implementing and integrating locally ablative modes of therapy into the treatment
strategy can increase the effectiveness additionally. In a best case scenario additional
systemic side effects can be avoided resulting in a not insignificant benefit in quality
of life. Results: Further genotyping beyond the K-RAS state is necessary to make predictive and prognostic
statements concerning the drugs applied and to avoid ineffectiveness. Conclusion: Considerable progress has been achieved in the medical therapy for metastasised colorectal
cancer. The targeted application of already available as well as recently developed
substances requires further evaluation by appropriate studies.
Schlüsselwörter
kolorektales Karzinom - EGFR-Antikörper - VEGF-Antikörper - MSI - KRAS BRAF - Chemotherapie
Key words
colorectal cancer - EGFR antibodies - VEGF antibodies - MSI - KRAS BRAF - chemotherapy
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Dr. P. Stübs
Otto-von-Guericke-Universität · Klinik für Allgemein-, Viszeral- und Gefäßchirurgie
Leipziger Straße 44
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