Der Internist

, Volume 46, Issue 12, pp 1339–1346 | Cite as

Welche Rolle spielen die neuen Therapieoptionen in der palliativen Therapie des Kolonkarzinoms?

Schwerpunkt: Was ist gesichert in der Therapie?

Zusammenfassung

Die Therapiemöglichkeiten des metastasierten kolorektalen Karzinoms wurden im letzten Jahr durch die Zulassung der monoklonalen Antikörper Bevacizumab und Cetuximab erneut bereichert. Die Antikörper sind die ersten Vertreter zweier hochinteressanter Therapiekonzepte: der Antiangiogenese bzw. der Inhibition des Epidermal Growth Factor (EGF) Rezeptors. Bevacizumab bindet an den vaskulären endothelialen Wachstumsfaktor und blockiert so dessen angiogenetische Wirkung. In einer Phase-III-Studie zeigte Bevacizumab in Kombination mit 5-Fluorouracil/Folinsäure/Irinotecan (IFL) im Vergleich zu IFL sowohl eine bessere Ansprechrate (45% vs. 35%) als auch eine Verlängerung des progressionsfreien (10,6 Monate vs. 6,2 Monate) und des Gesamtüberlebens (20,3 Monate vs. 15,6 Monate). Der Antikörper Cetuximab bindet an den EGF-Rezeptor und blockiert so dessen Aktivierung durch den natürlichen Liganden EGF. Bei irinotecanrefraktären Patienten erreicht Cetuximab zusammen mit Irinotecan bei 22,5% erneut ein Ansprechen. Das progressionsfreie Überleben wurde im Vergleich zu einer Cetuximabmonotherapie (4,1 Monate vs. 1,5 Monate) signifikant verlängert. Cetuximab stellt damit eine neue Option für diese ansonsten schwer therapierbare Patientengruppe dar.

Schlüsselwörter

Kolorektales Karzinom Bevacizumab Cetuximab Antiangiogenese 

Which role play new therapeutic options in palliative care of colorectal cancer?

Abstract

Therapeutic options in the treatment of metastatic colorectal cancer have recently been expanded by the introduction of two new monoclonal antibodies: bevacizumab and cetuximab. These antibodies were the proof of principle of two exciting new antitumor strategies: antiangiogenesis and inhibition of epidermal growth factor (EGF) receptor. Bevacizumab binds to vascular endothelial growth factor and thus blocks its angiogenic effects. In a randomized phase III trial bevacizumab in combination with irinotecan + 5-fluorouracil/leucovorin (IFL) was compared to chemotherapy alone as first-line treatment. The combination showed a superior response rate, a prolonged progression-free and overall survival. Cetuximab binds to the EGF receptor and thus inhibits its activation by its natural ligand. In a randomized phase II trial irinotecan refractory patients were treated with cetuximab alone or cetuximab plus irinotecan. The combination showed a response rate of 22,5% and a prolonged progression-free survival identifying cetuximab as an important new option for this patient group.

Keywords

Colorectal carcinoma Bevacizumab Cetuximab Antiangiogenesis 
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Notes

Interessenkonflikt:

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: U. Graeven Referentenhonorare Hoffmann LA Roche, Merk; Advisory Board Avastin der Fa. Hoffman La Roche U. Graeven.

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Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Medizinische Klinik IKrankenhaus St. Franziskus, Kliniken Mariahilf GmbhMönchengladbach
  2. 2.Medizinische Klinik IKrankenhaus St. Franziskus, Kliniken Mariahilf GmbHMönchengladbach

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