Aktuelle medikamentöse Therapie kolorektaler Karzinome – Standards im adjuvanten und im metastasierten Stadium

In der adjuvanten Situation profitieren Patienten mit einem Kolonkarzinom im Stadium III von einer Kombinationstherapie nach FOLFOX-Protokoll. Bei Kontraindikationen ist auch ein Verzicht auf Oxaliplatin möglich, in diesen Fällen empfiehlt sich aus Gründen der Praktikabilität die Therapie mit dem oralen Fluoropyrimidin Capecitabin. Risikopatienten im Stadium II sollten ebenfalls über die Möglichkeit einer adjuvanten Behandlung aufgeklärt werden.

Im metastasierten Stadium sollte jedem Patienten, sofern keine Kontraindikationen bestehen, alle wirksamen Medikamente (5-FU oder Capecitabin, Oxaliplatin, Irinotecan) angeboten werden. Die individuelle Situation und die Nebenwirkungsprofile der Substanzen sind wichtige Entscheidungshilfen für die Sequenz. Durch die Kombination von Chemotherapie mit Antikörpern (Bevacizumab sowie bei nachgewiesenem KRAS-Wildtyp auch Cetuximab oder Panitumumab) ist statistisch eine weitere Verlängerung des Gesamtüberlebens möglich. Bei Patienten mit begrenzter Metastasierung sollte immer auch die Resektabilität überprüft werden.

Combined therapy according to the FOLFOX protocol is of advantage to Stage III colocarcinoma adjuvant stage patients. In case of a contraindication it is also possible to abstain from oxaliplatin. In such cases it would be practicable to employ the oral fluoropyrimidine capecitabine. Stage II risk patients should also be informed about the possibility of an adjuvant treatment.

Every patient in the metastasized stage should be offered – if there are no contraindications – all the available effective preparations such as 5-FU or capecitabine, oxaliplatin, irinotecan. The choice between these substances is decisively determined by their side effects profile. The total survival rate may be statistically extended still further by combining chemotherapy with antibodies (bevacizumab as well as in case of an established KRAS wild-type also cetuximab or panitumumab). In case of patients with limited metastization, it would always be recommendable to consider the possibility of resection.

Key words

Colorectal carcinoma - medicamental - adjuvant therapy - metastasized stage - chemotherapy - monoclonal antibodies

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