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Medical treatment of gastrinomas

Medikamentöse Therapie des Gastrinoms

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Zusammenfassung

Gastrinome sind funktionell aktive neuroendokrine Tumoren des Gastro-Entero-Pankreatischen Systems. Die Operation ist die Primärtherapie der Wahl, welche jedoch häufig nicht kurativ ist. Dieser Übersichtsartikel stellt die aktuellen medikamentösen Therapiestrategien beim nicht operablen Gastrinom dar. Die symptomatische Therapie mit H+-K+-ATPase Protonenpumpeninhibitoren supprimiert die Hypersekretion von Magensäure und verbessert die Lebensqualität von Patienten mit Zollinger-Ellison Syndrom. Weitere medikamentöse Therapieansätze werden nur bei Gastrinomen mit progredienter Metastasierung empfohlen. Bei gut differenzierten neuroendokrinen Karzinomen (G1 and G2) stellt die Biotherapie mit Somatostatinanaloga die medikamentöse Firstline-Therapie dar; die Chemotherapie mit Streptocotozin plus Doxorubicine / 5-FU ist eine medikamentöse Secondline-Therapie. Bei gering differenzierten neuroendokrinen Karzinomen (G3) wird eine Chemotherapie mit Etoposid / Cisplatin empfohlen. Zukünftige Therapiestrategien von neuroendokrinen Karzinomen mit neuen Somatostatinanaloga, Angiogenesinhibitoren und Kinaseinhibitoren sind derzeit in klinischer Evaluation.

Summary

Gastrinomas are functional neuroendocrine tumors of the gastroenteropancreatic system. Surgery is first line treatment in gastrinomas, however often fails to be curative. This manuscript reviews current strategies of medical treatment of surgically non-curable gastrinoma. Symptomatic treatment with H+-K+-ATPase proton-pump inhibitors suppresses hypersecretion of gastric acid and substantially improves quality of life in patients with Zollinger-Ellison syndrome. Further medical therapy is only recommended in cases of progressive metastatic gastrinoma. In well differentiated neuroendocrine carcinoma (G1 and G2) a so-called biotherapy with somatostatinanalogues exists as first-line and chemotherapy with streptocotozin plus doxorubicine / 5-FU as second-line medical treatment option. In poorly differentiated neuroendocrine carcinoma (G3) chemotherapy with etoposide plus cisplatin is possible. Prospective future therapeutic strategies may include treatment with novel somatostain analogues as well as angiogenesis inhibitors and kinase inhibitors targeting tumor-specific signaling cascades.

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  1. Department of Internal Medicine II, Hospital of the University of Munich, Ludwig-Maximilians-University Munich, Munich-Großhadern, Germany

    Christoph J. Auernhammer & Burkhard Göke

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Auernhammer, C., Göke, B. Medical treatment of gastrinomas. Wien Klin Wochenschr 119, 609–615 (2007). https://doi.org/10.1007/s00508-007-0877-1

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