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Z Gastroenterol 2014; 52(8): 821-830
DOI: 10.1055/s-0034-1366774
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Inzidenz und Therapie von Chemotherapie-induzierter Nausea und Emesis bei gastrointestinalen Tumoren

Incidence and Treatment of Chemotherapy-Induced Nausea and Emesis in Gastrointestinal Cancer
S. Lorenzen
1   3rd Department of Internal Medicine (Hematology/Oncology), Klinikum rechts der Isar, Technische Universität München
,
S. Spörl
1   3rd Department of Internal Medicine (Hematology/Oncology), Klinikum rechts der Isar, Technische Universität München
,
F. Lordick
2   University Cancer Center Leipzig (UCCL), University Clinic Leipzig
› Institutsangaben
Weitere Informationen

Publikationsverlauf

02. Mai 2014

15. Juni 2014

Publikationsdatum:
11. August 2014 (online)

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Zusammenfassung

Gastrointestinale Tumoren (GIT) sind mit einer Zahl von ca. 2 Mio. Neuerkrankungen und ca. 1,2 Mio. Sterbefällen pro Jahr weltweit die häufigsten malignen Tumoren. Allein in Europa erkranken jedes Jahr ca. 500 000 Menschen an einem GIT. Die häufigsten chemotherapeutisch zu behandelnden Tumoren betreffen die Speiseröhre, den Magen, die Bauchspeicheldrüse, die Gallenwege sowie den Dickdarm. In den vergangenen Jahren konnte durch neue Substanzen und Kombinationstherapien eine Verbesserung der Prognose bei Patienten mit GIT erzielt werden. Durch neue Systemtherapien wurden auch die Anforderungen an die supportive Behandlung komplexer. In der Prävention von Chemotherapie-induzierter Nausea und Emesis (CINE) wurden erhebliche Fortschritte bei hoch und moderat emetogenen Schemata erzielt. In der Prävention von CINE bei hoch emetogener Chemotherapie erweist sich die Dreifachprophylaxe aus 5-HT3-Rezeptorantagonisten (RA), Dexamethason und einem NK1-RA, Aprepitant oder Fosaprepitant, einer Prophylaxe ohne NK1-RA überlegen. Für Patienten, die eine moderat emetogene Chemotherapie bekommen, ist die Therapie mit Palonosetron in Kombination mit Dexamethason nach den aktuellen Leitlinien unterschiedlicher Fachgesellschaften der empfohlene Standard. Insbesondere die Therapie der verzögerten Nausea und Emesis bei moderat emetogener Chemotherapie hat sich durch die Therapie mit Palonosetron, das als einziges Setron in dieser Indikation wirksam ist, entscheidend verbessert. Dieser Artikel beschreibt praxisnah die leitliniengerechte antiemetische Prophylaxe und Therapie bei GIT anhand der gängigen Chemotherapieregime.

Abstract

The incidence of gastrointestinal (GI) cancer is increasing, with approximately 2 million new cases diagnosed worldwide and about 1.2 million patients dying per year. In Europe, about 500 000 people per year are newly diagnosed with GI cancer. The most frequent cancer types that undergo chemotherapy include cancer of the oesophagus, stomach, pancreas, biliary tract and colorectum. In the last years, various new agents and combinations have been demonstrated to improve the prognosis of patients with GI cancer. However, with the introduction of new and more effective systemic treatments, the need for supportive treatment has become more complex. There has been significant improvement in the management of nausea and vomiting arising from highly and moderately emetogenic chemotherapy. Nevertheless, vomiting and especially nausea continue to be two of the most distressing side effects of antineoplastic treatment. For the prevention of chemotherapy-induced nausea and vomiting in highly emetogenic therapy, a triple therapy including a 5-HT3-receptor antagonist (RA), dexamethasone and an NK1-RA, aprepitant or fosaprepitant are recommended. In moderately emetogenic regimens, updated guidelines recommend the combination of the second-generation 5-HT3-RA palonosetron with dexamethasone, providing improved protection against acute nausea and vomiting, and demonstrating superior prevention in the delayed phase. This review provides an update of the revised clinical guidelines for antiemetic treatment and prophylaxis in GI cancer patients receiving chemotherapy.

Schlüsselwörter

gastro-entero-pankreatische Tumoren - Magenkarzinom - kolorektales Karzinom

Key words

gastro-entero-pancreatic tumours - stomach cancer - colorectal carcinoma
 

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