Zusammenfassung
Das kolorektale Karzinom ist mit fast 30.000 Todesfällen pro Jahr hierzulande die zweithäufigste krebsbedingte Todesursache. Noch immer verstirbt fast jeder 2. Patient an der Erkrankung. Im letzten Jahrzehnt konnte durch die Einführung neuer, effektiver Chemotherapeutika und biologischer Substanzen die medikamentöse Therapie entscheidend verbessert werden. Beim Kolonkarzinom im Stadium III gilt eine adjuvante Kombinationstherapie mit Oxaliplatin als Standardtherapie. Im metastasierten Stadium ist für einen Teil der Patienten entweder durch eine primäre Resektion oder durch eine sekundäre Resektion der Metastasen nach neoadjuvanter Kombinationstherapie und Verkleinerung der Tumoren eine Heilung möglich. In der palliativen Therapie ist bei tumorbedingten Symptomen oder raschem Progress der Erkrankung eine intensive Kombinationstherapie indiziert. Das Therapieziel ist die Verlängerung des Überlebens bei akzeptabler Lebensqualität. Durch die Kombination mit zielgerichteten Substanzen wird eine weitere Verbesserung des Überlebens erreicht. Darüber hinaus wurde vor Kurzem mit dem Mutationsstatus des KRAS-Onkogens ein erster prädiktiver molekularer Marker in die klinische Praxis eingeführt, was einen entscheidenden ersten Schritt hin zu einer Individualisierung der Therapie beim kolorektalen Karzinom darstellt.
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer death in the western world. Almost every second patient dies of the disease. The introduction of new and effective chemotherapeutic substances and biologics in the past decade has significantly improved the systemic treatment of patients with CRC. In stage III colon cancer combination chemotherapy with oxaliplatin is the standard of care. In stage IV cancer the choice of therapy is dependent on the clinical status of the patient. For some patients primary resection of metastases or resection after combination therapy and downsizing of lesions offers a chance for cure. In the palliative setting intensive combination treatment is indicated if the patient suffers from tumor related symptoms or a rapid progress of the disease. The aim of palliative therapy is the prolongation of survival and the improvement of quality of life. Combination with monoclonal antibodies leads to further improvement of survival. Furthermore, the introduction of the mutational status of the KRAS oncogene as the first predictive marker into clinical care is an important step towards the individualization of treatment in CRC.
Abbreviations
- 5-FU:
-
5-Fluorouracil
- 5-FU/FS:
-
5-Fluorouracil/Folinsäure
- 5-JÜR:
-
5-Jahres-Überlebensrate
- ASCO:
-
American Society of Clinical Oncology
- BICC:
-
„Bolus, Infusional or Capecitabine with Camptosar-Celecoxib“ Studie
- BRAF:
-
Humanes Onkogen: V-raf murine sarcoma viral oncogene homolog B1
- CAIRO:
-
„CApecitabine, IRinotecan, Oxaliplatin“ Studie
- CASH:
-
Chemotherapie-assoziierte Steatohepatitis
- CEA:
-
Karzinoembryonales Antigen
- CELIM:
-
„CEtuximab in neoadjuvant treatment of non-resectable colorectal LIver Metastases“ Studie
- CRC:
-
Colorectal cancer
- CPT-11:
-
Irinotecan
- CRYSTAL:
-
„Cetuximab combined with iRinotecan in first line therapY for metaSTatic colorectAL cancer“ Studie
- DFS:
-
Erkrankungsfreies Überleben
- DTZ:
-
Disseminierte Tumorzellen
- EGFR:
-
Epidermal Growth Factor Receptor
- EORTC:
-
European Organisation for Research and Treatment of Cancer
- FOLFIRI:
-
Kombinationschemotherapie mit Irinotecan, 5-FU und Folinsäure
- FOLFOX:
-
Kombinationschemotherapie mit Oxaliplatin, 5-FU und Folinsäure
- HAI:
-
Hepatic Artery Infusion
- HES:
-
Hyperexzitabilitätssyndrom
- HR:
-
Hazard Ratio
- IGF-1R:
-
Insulin-like Growth Factor 1 Receptor
- KRK:
-
Kolorektales Karzinom
- KRAS:
-
Kirsten rat sarcoma viral homolog Oncogen
- MOSAIC:
-
„Multi-center international study of oxaliplatin/5-fluorouracil/leucovorin in the adjuvant treatment of colon cancer“ Studie
- MTOR:
-
Mammalian Target of Rapamycin
- NSABP:
-
National Surgical Adjuvant Breast and Bowel Project Studiengruppe
- OS:
-
Gesamtüberleben
- PETACC:
-
Pan-European Trials in Adjuvant Colon Cancer Studiengruppe
- PFS:
-
Progressionsfreies Überleben
- PSN:
-
Periphere sensible Neuropathie
- RECIST:
-
Response Evaluation Criteria In Solid Tumors, Kriterien zur Evaluierung des Therapieansprechens bei soliden Tumoren
- SOS:
-
Sinusoidales Obstruktionssyndrom
- TNM:
-
Tumorklassifikation nach der UICC (6. Auflage, 2002)
- UICC:
-
Union internationale contre le cancer (UICC)
- VEGF:
-
Vascular Endothelial Growth Factor
- X-Act:
-
„Xeloda in Adjuvant Colon Cancer Therapy“ Studie
- XELOX:
-
Kombinationschemotherapie mit Capecitabin und Oxaliplatin
- XELIRI:
-
Kombinationschemotherapie mit Capecitabin und Irinotecan, Synonym CapIri
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Der korrespondierende Autor weist auf folgende Beziehungen hin:
Prof. Dr. Schmiegel ist als Referent und gegen Beraterhonorar für die Firmen Astra-Zeneca, Roche, and Sanofi-Aventis tätig, PD Dr. Reinacher-Schick als Referent und gegen Beraterhonorar für die Firmen Amgen, Roche and Sanofi-Aventis, Dr. Pohl als Referent für die Firmen Roche und Amgen.
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Reinacher-Schick, A., Pohl, M. & Schmiegel, W. Die medikamentöse Therapie des kolorektalen Karzinoms. Internist 50, 1239–1252 (2009). https://doi.org/10.1007/s00108-009-2508-6
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DOI: https://doi.org/10.1007/s00108-009-2508-6