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Medikamentöse Therapie bei metastasierten neuroendokrinen Tumoren des gastroenteropankreatischen Systems

Medicinal therapy of metastasized neuroendocrine tumors of the gastroenteropancreatic system

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Wiener klinisches Magazin Aims and scope

Zusammenfassung

Neuroendokrine Neoplasien des gastroenteropankreatischen Systems werden nach der WHO-Klassifikation 2010 in neuroendokrine Tumoren (NET) und neuroendokrine Karzinome (NEC) unterteilt. Im klinischen Alltag spielt bei NET das Grading mithilfe des Ki-67-Proliferationsindex zur Prognoseabschätzung und Therapieplanung eine essenzielle Rolle. Zudem differieren die Tumorbiologie sowie die Therapieoptionen bei NET je nach Primariuslokalisation. Die palliative Therapie bei inoperablen NET umfasst lokal-ablative Maßnahmen bei ausschließlicher Lebermetastasierung, die peptidrezeptorvermittelte Radiotherapie (PRRT) bei Tumoren, die Somatostatinrezeptoren exprimieren, und verschiedene medikamentöse Therapieoptionen. In diesem Beitrag wird der aktuelle Stellenwert der Biotherapie mit Somatostatinanaloga und Interferon-α in der Symptom- und Tumorkontrolle beschrieben. Zudem werden die konventionelle Chemotherapie und neu zugelassene molekular zielgerichtete Therapieansätze mit Sunitinib und Everolimus bei NET des Pankreas dargestellt. Mögliche Therapiealgorithmen werden diskutiert.

Abstract

Neuroendocrine neoplasms of the gastroenteropancreatic system are classified according to the WHO classification system 2010 into neuroendocrine tumors (NET) and neuroendocrine carcinomas (NEC). The proliferation index Ki-67 and the grading of NETs is essential for the prognosis and therapy plan. Also NET tumor biology and therapeutic options may differ depending on the primary NET tumor location. Palliative therapy of inoperable NETs involves local ablative methods in cases of primary liver metastasis, peptide receptor radionuclide therapy (PRRT) in NETs expressing somatostatin receptors and different options for medicinal therapy. This manuscript reviews the current role of biotherapy with somatostatin analogues and interferon-alpha for symptom and tumor control. In addition conventional chemotherapy regimens and novel molecular targeted therapeutic options, such as sunitinib or everolimus in NET of the pancreas are reviewed. Possible therapeutic algorithms are discussed.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: C.J. Auernhammer hat in Zusammenhang mit dem Thema „neuroendokrine Tumoren“ Forschungsgelder (Ipsen, Novartis) sowie Honorare für Vortragstätigkeiten (Ipsen, Novartis, Pfizer, Roche, Falk Foundation) und Tätigkeiten in wissenschaftlichen Beiräten (Ipsen, Novartis) erhalten.

C. Spitzweg hat in Zusammenhang mit dem Thema „neuroendokrine Tumoren“ Forschungsgelder (Novartis) sowie Honorare für Vortragstätigkeiten (Ipsen, Novartis) und Tätigkeiten in wissenschaftlichen Beiräten (Novartis) erhalten.

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Authors and Affiliations

  1. Medizinische Klinik II, Campus Großhardern, Klinikum der Ludwigs-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    C.J. Auernhammer, C. Spitzweg & B. Göke

  2. Interdisziplinäres Zentrum für Neuroendokrine Tumoren des Gastroenteropankreatischen Systems (GEPNET-KUM), Klinikum der Ludwigs-Maximilians-Universität München, München, Deutschland

    C.J. Auernhammer, C. Spitzweg, V. Heinemann & B. Göke

  3. Medizinische Klinik III, Campus Großhardern, Klinikum der Ludwigs-Maximilians-Universität München, München, Deutschland

    V. Heinemann

Authors
  1. C.J. Auernhammer
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  2. C. Spitzweg
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  3. V. Heinemann
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  4. B. Göke
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Corresponding author

Correspondence to C.J. Auernhammer.

Additional information

Dieser Beitrag wurde bereits in Der Internist Heft 2, 2012, S.167-176, doi 10.1007/s00108-011-2919-z publiziert.

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Auernhammer, C., Spitzweg, C., Heinemann, V. et al. Medikamentöse Therapie bei metastasierten neuroendokrinen Tumoren des gastroenteropankreatischen Systems. Wien klin Mag 16, 16–23 (2013). https://doi.org/10.1007/s00740-013-0114-7

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  • DOI: https://doi.org/10.1007/s00740-013-0114-7

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