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Adjuvante Therapie des Kolonkarzinoms

Adjuvant therapy in colon cancer

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Zusammenfassung

Das Kolonkarzinom gehört zu den häufigsten Tumorentitäten und wird bei der Mehrheit der Patienten im lokalisierten Stadium diagnostiziert. Das Rezidivrisiko schwankt je nach Stadium zwischen 10 und 80%, kann aber bei Risikopatienten mit einer postoperativen Chemotherapie in relevantem Maße gesenkt werden. Im Stadium III ist die adjuvante Chemotherapie eindeutig indiziert, sofern keine Kontraindikationen vorliegen. Im Stadium II hat die Chemotherapie einen nur marginalen Effekt auf das rezidivfreie Überleben und wird daher nicht routinemäßig empfohlen. Bei Vorliegen von Risikofaktoren wie Perforation, unzureichender Anzahl untersuchter Lymphknoten etc. kann die Chemotherapie jedoch auch im Stadium II eine relevante Verbesserung bringen und sollte individuell mit den Patienten diskutiert werden. Es wird die Kombination aus Oxaliplatin plus 5-FU/Folinsäure (FOLFOX) empfohlen. Alternativ können auch orale Fluoropyrimidine als Monotherapie gegeben werden.

Neueste Daten lassen den Vorteil der adjuvanten Chemotherapie bei älteren Patienten fraglich erscheinen. Weiterhin konnte die erste Studie von Bevacizumab in der adjuvanten Situation nicht die gestellten Erwartungen erfüllen.

Abstract

Colon cancer is one of the leading cancer diseases in the Western world, with most patients having localized tumors upon their initial diagnosis. Adjuvant chemotherapy is clearly recommended for patients with Dukes C disease. In Dukes B colon cancer, chemotherapy has only marginal effects and is therefore not routinely recommended. However, in patients with risk factors such as insufficient lymph node removal, perforation, etc., chemotherapy might have more impact and should be individually discussed with the patient. Routinely, the combination of oxaliplatin plus 5FU/LV (FOLFOX) should be used. Oral fluoropyrimidines may be given alternatively.

Recent results questioned the benefit of adjuvant chemotherapy in elderly patients. Data on bevacizumab combined with FOLFOX did not meet the expectations and will be discussed in detail.

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Literatur

  1. Krebs in Deutschland 2003–2004 (2008) Häufigkeiten und Trends. 6. überarbeitete Aufl. ed. Robert Koch-Institut (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (Hrsg), Berlin

  2. Klinkhammer-Schalke M (2008) 2. Bundesweite onkologische Qualitätskonferenz Kooperationsverbund Qualitätssicherung durch klinische Krebsregister. In: 28. Deutscher Krebskongress 2008

  3. Wittekind C, Bootz N, Meyer H (2005) TNM. Klassifikation maligner Tumoren. 6 edn. Springer, Berlin

  4. O’Connell JB, Maggard MA, Ko CY (2004) Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 96(19):1420–1425

    Article  Google Scholar 

  5. Greene FL, Stewart AK, Norton HJ (2002) A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients. Ann Surg 236(4):416–421 discussion 421

    Article  PubMed  Google Scholar 

  6. George S, Primrose J, Talbot R et al (2006) Will Rogers revisited: prospective observational study of survival of 3592 patients with colorectal cancer according to number of nodes examined by pathologists. Br J Cancer 95(7):841–847

    Article  CAS  PubMed  Google Scholar 

  7. Schmiegel W, Reinacher-Schick A, Arnold D et al (2008) Update S3-guideline „colorectal cancer“ 2008. Z Gastroenterol 46(8):799–840

    Article  CAS  PubMed  Google Scholar 

  8. Sargent DJ, Patiyil S, Yothers G et al (2007) End points for colon cancer adjuvant trials: observations and recommendations based on individual patient data from 20,898 patients enrolled onto 18 randomized trials from the ACCENT Group. J Clin Oncol 25(29):4569–4574

    Article  PubMed  Google Scholar 

  9. Sargent D (2009) Use of two-year disease-free survival (DFS) as a primary endpoint in stage III adjuvant colon cancer trials with fluoropyrimidines with or without oxaliplatin or irinotecan: New data from 12,676 patients from MOSAIC, X-ACT, PETACC-3, NSAPB C-06 and C-07, and C89803. J Clin Oncol 27:15 s (suppl; abstr 4011)

    Article  Google Scholar 

  10. Sargent DJ, Goldberg RM, Jacobson SD et al (2001) A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 345(15):1091–1097

    Article  CAS  PubMed  Google Scholar 

  11. Chau I, Norman AR, Cunningham D et al (2005) A randomised comparison between 6 months of bolus fluorouracil/leucovorin and 12 weeks of protracted venous infusion fluorouracil as adjuvant treatment in colorectal cancer. Ann Oncol 16(4):549–557

    Article  CAS  PubMed  Google Scholar 

  12. Bayraktar UD, Bayraktar S, Herna S et al (2009) Does delay of adjuvant chemotherapy affect the clinical outcome in patients with colon cancer? J Clin Oncol 27:15 s (suppl; abstr 4046)

    Article  Google Scholar 

  13. Andre T, Boni C, Mounedji-Boudiaf L et al (2004) Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 350(23):2343–2351

    Article  CAS  PubMed  Google Scholar 

  14. O’Connell MJ, Laurie JA, Kahn M et al (1998) Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer. J Clin Oncol 16(1):295–300

    Google Scholar 

  15. Arkenau HT, Rettig K, Porschen R (2005) Adjuvant chemotherapy in curative resected colon carcinoma: 5-fluorouracil/leucovorin versus high-dose 5-fluorouracil 24-h infusion/leucovorin versus high-dose 5-fluorouracil 24-h infusion. Int J Colorectal Dis 20(3):258–261

    Article  CAS  PubMed  Google Scholar 

  16. Chau I, Allen MJ, Cunningham D, Norman AR et al (2004) The value of routine serum carcino-embryonic antigen measurement and computed tomography in the surveillance of patients after adjuvant chemotherapy for colorectal cancer. J Clin Oncol 22(8):1420–1429

    Article  CAS  PubMed  Google Scholar 

  17. Twelves C, Wong A, Nowacki MP et al (2005) Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352:2696–2704

    Article  CAS  PubMed  Google Scholar 

  18. Lembersky BC, Wieand HS, Petrelli NJ et al (2006) Oral uracil and tegafur plus leucovorin compared with intravenous fluorouracil and leucovorin in stage II and III carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project Protocol C-06 JCO 2059–2064

  19. André T, Boni C, Navarro M, Tabernero J et al (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 27(19):3109–3116

    Article  PubMed  CAS  Google Scholar 

  20. Wolmark N, Wieand S, Kuebler JP et al (2005) A phase III trial comparing FULV to FULV + oxaliplatin in stage II or III carcinoma of the colon: Results of NSABP Protocol C-07. J Clin Oncol (Meeting Abstracts) 23:LBA3500

    Google Scholar 

  21. Kuebler JP, Colangelo L, O’Connell MJ et al (2007) Severe enteropathy among patients with stage II/III colon cancer treated on a randomized trial of bolus 5-fluorouracil/leucovorin plus or minus oxaliplatin: a prospective analysis. Cancer 110(9):1945–1950

    Article  CAS  PubMed  Google Scholar 

  22. McCleary NA, Meyerhardt J, Green E et al (2009) Impact of older age on the efficacy of newer adjuvant therapies in >12,500 patients (pts) with stage II/III colon cancer: Findings from the ACCENT Database. J Clin Oncol 27:15 s (suppl; abstr 4010)

    Article  Google Scholar 

  23. Allegra CJ, Yothers G, O’Connell MJ et al (2009) Initial Safety Report of NSABP C-08: A Randomized Phase III study of modified FOLFOX6 With or Without Bevacizumab for the adjuvant treatment of patients with Stage II or III colon cancer. J Clin Oncol 3385–3390

  24. Schmoll H-J, Cartwright T, Tabernero J et al (2007) Phase III trial of capecitabine plus oxaliplatin as adjuvant therapy for stage III colon cancer: a planned safety analysis in 1,864 patients J Clin Oncol 25(1):102–109

    Google Scholar 

  25. Saltz LB, Niedzwiecki D, Hollis D et al (2007) Irinotecan fluorouracil plus leucovorin is not superior to fluorouracil plus leucovorin alone as adjuvant treatment for stage III colon cancer: results of CALGB 89803. J Clin Oncol 25(23):3456–3461

    Article  CAS  PubMed  Google Scholar 

  26. Van Cutsem E, Labianca R, Bodoky G et al (2009) Randomized phase III trial comparing biweekly infusional fluorouracil/leucovorin alone or with irinotecan in the adjuvant treatment of stage III colon cancer: PETACC-3. J Clin Oncol 27(19):3117–3125

    Article  CAS  Google Scholar 

  27. Figueredo A, Charette ML, Maroun J et al (2004) Adjuvant therapy for stage II colon cancer: a systematic review from the Cancer Care Ontario Program in evidence-based care’s gastrointestinal cancer disease site group. J Clin Oncol 22(16):3395–3407

    Article  PubMed  Google Scholar 

  28. Benson AB 3rd, Schrag D, Somerfield MR et al (2004) American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22(16):3408–3419

    Article  PubMed  Google Scholar 

  29. Quasar Collaborative Group, Gray R, Barnwell J et al (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370(9604):2020–2029

    Article  CAS  Google Scholar 

  30. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99(6):433–441

    Article  PubMed  Google Scholar 

  31. Mamounas E, Wieand S, Wolmark N et al (1999) Comparative efficacy of adjuvant Chemotherapy in patients with Dukes‘ B versus Dukes‘ C colon cancer: Results from four National Surgical Adjuvant Breast and Bowel Project Adjuvant Studies (C-01, C-02, C-03, and C-04) JCO 1349

  32. Wolmark N (2009) A phase III trial comparing mFOLFOX6 to mFOLFOX6 plus bevacizumab in stage II or III carcinoma of the colon: Results of NSABP Protocol C-08. J Clin Oncol 27:18 s (suppl; abstr LBA4)

    Article  Google Scholar 

  33. Kohonen-Corish MR, Daniel JJ, Chan C et al (2005) Low microsatellite instability is associated with poor prognosis in stage C colon cancer. J Clin Oncol 23(10):2318–2324

    Article  CAS  PubMed  Google Scholar 

  34. Bertagnolli MM, Niedzwiecki D, Compton CC et al (2009) Microsatellite instability predicts improved response to adjuvant therapy with irinotecan, fluorouracil, and leucovorin in stage III colon cancer: Cancer and Leukemia Group B Protocol 89803. J Clin Oncol 27(11):1814–1821

    Article  CAS  PubMed  Google Scholar 

  35. Tejpar S, Bosman F, Delorenzi M et al (2009) Microsatellite instability (MSI) in stage II and III colon cancer treated with 5FU-LV or 5FU-LV and irinotecan (PETACC 3-EORTC 40993-SAKK 60/00 trial). J Clin Oncol 27:15 (suppl; abstr 4001)

    Article  Google Scholar 

  36. Roth AD, Tejpar S, Yan P et al (2009) Stage-specific prognostic value of molecular markers in colon cancer: Results of the translational study on the PETACC 3-EORTC 40993-SAKK 60–00 trial. J Clin Oncol 27:15 s (suppl; abstr 4002)

    Article  Google Scholar 

  37. Kerr D, Gray R, Quirke P et al (2009) A quantitative multigene RT-PCR assay for prediction of recurrence in stage II colon cancer: Selection of the genes in four large studies and results of the independent, prospectively designed QUASAR validation study. J Clin Oncol 27:15 s (suppl; abstr 4000)

    Article  Google Scholar 

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Authors and Affiliations

  1. Onkologie, Hämatologie und Knochenmarktransplantation mit Sektion Pneumologie, Universitäres Cancer Center Hamburg – Hubertuswald Tumorzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20 246, Hamburg, Deutschland

    G. Schuch, D. Arnold & C. Bokemeyer

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  1. G. Schuch
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  2. D. Arnold
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Correspondence to G. Schuch.

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Schuch, G., Arnold, D. & Bokemeyer, C. Adjuvante Therapie des Kolonkarzinoms. Onkologe 15, 1215–1222 (2009). https://doi.org/10.1007/s00761-009-1722-0

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