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Internistisch-onkologische Aspekte bei der Behandlung des Pankreaskarzinoms

Medical-oncological aspects in the treatment of pancreatic cancer

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Zusammenfassung

Das Pankreaskarzinom ist eine hochmaligne Erkrankung, die trotz nachweisbarer klinischer Fortschritte weiterhin mit einem meist kurzen Überleben verbunden ist.

Bei R0/R1-resezierten Patienten gilt eine adjuvante Behandlung mit Gemcitabin gegenwärtig als etablierter Behandlungsstandard. Weniger eindeutig ist die optimale Therapie des lokal fortgeschrittenen, nichtmetastasierten Pankreaskarzinoms (LAPC). Es gibt aber Hinweise dafür, dass Patienten, die auf eine initiale Chemotherapiephase ansprachen, von einer nachgeschalteten Radiochemotherapie profitieren können. Gerade zur Behandlung des metastasierten Pankreaskarzinoms sollten die Chemo- oder die Radiochemotherapie nicht allein stehen, sondern durch multidisziplinäre Behandlungsansätze unterstützt werden. Dazu gehören die Schmerz- und Ernährungstherapie, Psychoonkologie und Palliativmedizin. Bei der Behandlung des metastasierten Pankreaskarzinoms gehören die Gemcitabin-Monotherapie sowie auch die Kombination aus Gemcitabin und Erlotinib zu den etablierten Standards.

Nach Versagen einer Gemcitabin-basierten Therapie sollte Patienten in gutem Allgemeinzustand eine Zweitlinientherapie angeboten werden.

Abstract

Pancreatic cancer is a highly malignant disease and despite progress in systemic therapy survival is still short. For patients with R0/R1 resected disease, adjuvant chemotherapy with gemcitabine has been established as the standard treatment. More controversy exists with regard to optimal treatment of locally advanced non-metastatic pancreatic cancer. However, there is evidence to suggest that patients who respond to an initial phase of chemotherapy may be those who benefit most from sequential chemoradiotherapy. Specifically, in the treatment of advanced and metastatic disease chemotherapy or radiotherapy cannot stand alone but must be accompanied by multidisciplinary treatment approaches involving pain management, weight control, psychooncological care and palliative care. Monotherapy with gemcitabine and the combined use of gemcitabine with erlotinib are established standards for treatment of metastatic pancreatic cancer. Patients in a good general condition but where the gemcitabine-based therapy failed should be offered second-line treatment.

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Interessenkonflikt

Firma Roche: Honorare für Vorträge und Teilnahme an Advisory Boards.

Finanzielle Unterstützung im Rahmen klinischer Studien.

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  1. Medizinische Klinik und Poliklinik III, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    V. Heinemann

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Correspondence to V. Heinemann.

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Heinemann, V. Internistisch-onkologische Aspekte bei der Behandlung des Pankreaskarzinoms. Radiologe 49, 144–148 (2009). https://doi.org/10.1007/s00117-008-1753-3

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