Der Onkologe

, Volume 20, Issue 8, pp 725–732

Systemtherapie des metastasierten kolorektalen Karzinoms

Leitthema
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Zusammenfassung

Hintergrund

Die Systemtherapie des metastasierten kolorektalen Karzinoms soll eine möglichst lange Lebenszeit bei guter Lebensqualität der Patienten gewährleisten. Hierbei wird das Konzept der streng abgegrenzten Therapielinien immer mehr verlassen und stattdessen durch eine individuelle Therapieplanung ersetzt, welche auch Erhaltungstherapien einschließt und sich nach der Tumorausbreitung und Tumorbiologie, dem klinischen Zustand des Patienten sowie den auftretenden Nebenwirkungen ausrichtet.

Methode

Literaturrecherche und Auswertung klinischer Studien.

Ergebnisse und Schlussfolgerungen

Da die Erstlinien-Kombinationschemotherapie mit einem Anti-EGFR-Antikörper von kolorektalen RAS-Wild-Typ(wt)-Karzinomen (K- und NRAS Exon 2, 3 und 4) mit einem signifikanten Überlebensvorteil für die Patienten verbunden sein könnte, sollte bei allen Patienten, für die eine intensive Erstlinien-Kombinationschemotherapie in Frage kommt, der komplette RAS-Status vor Therapiebeginn bestimmt werden. Um den Patienten potenzielle Heilungschancen oder auch längere systemtherapiefreie Intervalle zu geben, ist es essenziell, dass bei limitierter Leber- und/oder Lungenmetastasierung die vollständige Entfernung des Tumors durch einen chirurgischen Eingriff und/oder lokale Tumorablation im Auge behalten wird, auch wenn diese nur durch eine Konversion nach einer intensiven Induktionschemotherapie möglich erscheint. Hierfür ist eine enge Abstimmung mit einem ausgewiesenen Chirurgen im Rahmen von interdisziplinären Tumorkonferenzen vor und im Verlauf der Systemtherapie notwendig.

Schlüsselwörter

Kolorektales Karzinom RAS-Status Erstlinientherapie Zweitlinientherapie Drittlinientherapie 

Systemic therapy of metastatic colorectal cancer

Abstract

Context

Systemic chemotherapy of patients with metastatic colorectal cancer should provide a long overall survival time together with a high quality of life. Today, systemic chemotherapy of colorectal cancer in different stringent therapeutic lines is frequently replaced by a more individual strategy including maintenance therapies.

Method

Research of the literature and analysis of clinical trials.

Results and conclusions

The individual therapeutic strategy is dependent on the age, performance status and comorbidities of the patient as well as the extent and biology of the tumor, the course of the disease and the side effects of the therapy. In all cases where a first line combination chemotherapy is considered, analysis of the complete Ras-status (K-Ras and N-Ras exons 2, 3 and 4) is recommended before the onset of systemic therapy. There is evidence that first line combination chemotherapy with an anti-epidermal growth factor receptor (EGFR) antibody will improve overall survival of patients with Ras wild type tumors. Limited liver and/or lung metastasis should be considered for R0 resection, even if this only seems possible after tumor shrinkage during the course of an intensive induction therapy. The R0 resection of metastases provides a curative option for these patients or at least a long chemotherapy-free interval. In order to obtain the best outcome for patients with metastatic colorectal cancer, a close cooperation of medical oncologists and surgeons in interdisciplinary tumor conferences at the beginning and during the course of systemic therapy is essential.

Keywords

Colorectal cancer Ras status First line therapy Second line therapy Third line therapy 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Medizinische Klinik IKreisklinik ReutlingenReutlingenDeutschland

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