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Zukunft der Chemotherapie

Future of chemotherapy

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Zusammenfassung

Anhand der erzielten Fortschritte bei der Chemotherapie soll die zukünftige Entwicklung abgeleitet werden. Bei der Indikationsstellung zur adjuvanten Therapie erfolgt zunehmend eine standardisierte Ermittlung des Rezidivrisikos unter Verwendung aller Prognoseparameter (z. B. Nomogramme). Bei einigen Tumoren ist die Entwicklung „molekularer Klassifizerer“, die die biologischen Eigenschaften eines Tumors anhand molekularer Veränderungen beschreiben, weit fortgeschritten.

In der adjuvanten Therapie könnten mit neuen Zytostatika sowie sequentiellen, dosisdichten bzw. -intensivierten Protokollen erhebliche Verbesserungen erzielt werden. Dagegen ist im metastasierten Stadium zumindest quo ad vitam kein Durchbruch zu erwarten. Hier sollte zukünftig noch mehr Wert auf den Erhalt der Lebensqualität gelegt werden.

Durch „targeted drugs“ oder deren Kombination mit einer Chemotherapie sind Fortschritte sowohl in der adjuvanten Therapie als auch im metastasierten Stadium erzielt worden; zahlreiche dieser Substanzen sind in der klinischen Entwicklung. Vor allem eine Klärung des Zusammenhangs zwischen Nachweis des „Targets“ und Wirksamkeit wird zu fundamentalen Änderungen bestehender Therapiekonzepte führen.

Abstract

The future development of chemotherapy is derived based upon recent advances. With regard to adjuvant therapy a trend towards standardized prediction of recurrence risk using all available prognostic markers (e.g., nomograms) is observed. Furthermore, in some tumors major progress has been made regarding the development of “molecular classifiers” defining tumor biology (predicting clinical outcome) by analysis of molecular changes.

In adjuvant therapy considerable advances may be achieved by use of new chemotherapeutic agents as well as sequential, dose-dense and dose-intensified regimens. However, in metastatic disease no breakthrough can be expected at least with regard to survival suggesting that quality of life needs to be addressed with more emphasis.

Using targeted drugs alone or in combination with chemotherapy advances concerning adjuvant therapy as well as metastatic disease are observed. Further targeted drugs have entered clinical development. However, clarification of the relation between detection of the target(s) and drug activity will fundamentally change current treatment concepts.

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Literatur

  1. Bergsland EK (2006) When does the presence of the target predict response to the targeted agent? J Clin Oncol 24(2): 213–216

    Article  PubMed  Google Scholar 

  2. Brenner H, Stegmaier C, Ziegler H (2005) Verbesserte Langzeitüberlebensraten von Krebspatienten. Dtsch Ärzteblatt 112(39): 2628–2633

    Google Scholar 

  3. Citron ML, Berry DA, Cirrincione C et al. (2003) Randomized Trial of Dose-Dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: First report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 21: 1431–1439

    Article  PubMed  Google Scholar 

  4. de Gramont A, Boni C, Navarro M et al. (2005) Oxaliplatin/5FU/LV in the adjuvant treatment of stage II and stage III colon cancer: Efficacy results with a median follow-up of 4 years. J Clin Oncol 23 [Suppl]: 3501

    Google Scholar 

  5. Escudier B, Szczylik C, Eisen T et al. (2005) Randomized phase III trial of the Raf kinase and VEGFR inhibitor sorafenib (BAY 43–9006) in patients with advanced renal cell carcinoma (RCC). J Clin Oncol 23 [Suppl]: 4510

    Google Scholar 

  6. Foekens JA, Atkins D, Zhang Y et al. (2006) Multicenter validation of a gene expression-based prognostic signature in lymph node-negative primary breast cancer. J Clin Oncol 24: 1665–1671

    Article  PubMed  Google Scholar 

  7. Hamilton A, Hortobagyi G (2005) Chemotherapy: what progress in the last 5 years? J Clin Oncol 23: 1760–1775

    Article  PubMed  Google Scholar 

  8. Herbst RS, Bajorin DF, Bleiberg H et al. (2006) Clinical Cancer Advances 2005: major research advances in cancer treatment, prevention, and screening – a report from the American Society of Clinical Oncology. J Clin Oncol 24: 190–205

    Article  PubMed  Google Scholar 

  9. Hölzel D, Engel J, Schubert-Fritschle G, Mansmann U (2006) Diskussion zu dem Beitrag: Verbesserte Langzeitüberlebensraten von Krebspatienten. Dtsch Ärzteblatt 103(10): 519–520

    Google Scholar 

  10. Johnson DH, Fehrenbacher L, Novotny WF et al. (2004) Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol 22: 2184–2191

    Article  PubMed  Google Scholar 

  11. Kattan MW, Wheeler TM, Scardino PT (1999) Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer. J Clin Oncol 17: 1499–1507

    PubMed  Google Scholar 

  12. Leibovich BC, Blute ML, Cheville JC et al. (2003) Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer 97: 1663–1671

    Article  PubMed  Google Scholar 

  13. Mamounas E, Tang G, Bryant J et al. (2005) Association between the 21-gene recurrence score assay (RS) and risk of loco-regional failure in node-negative, er-positive breast cancer: Results from NSABP B-14 and NSABP B-20. San Antonio Breast Cancer Symposium, p 29, http://www.genomichealth.com/pressroom/postersandabstracts.aspx?FileMaterialID=19

  14. Petrylak DP, Tangen CM, Hussain MH et al. (2004) Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Engl J Med 351: 1513–1520

    Article  PubMed  Google Scholar 

  15. Piccart-Gebhart MJ (2005). Moving away from the „one shoe fits all“ strategy: the key to future progress in chemotherapy. J Clin Oncol 23(8): 1611–1613

    Article  PubMed  Google Scholar 

  16. Piccart-Gebhart MJ, Procter M, Leyland-Jones B et al. (2005) Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med 353: 1659–1672

    Article  PubMed  Google Scholar 

  17. Romond EH, Perez EA, Bryant J et al. (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353: 1673–1684

    Article  PubMed  Google Scholar 

  18. Sandler AB, Gray R, Brahmer J et al. (2005). Randomized phase II/III trial of paclitaxel (P) plus carboplatin (C) with or without bevacizumab (NSC #704865) in patients with advanced non-squamous non-small cell lung cancer (NSCLC): An Eastern Cooperative Oncology Group (ECOG) trial – E4599. J Clin Oncol 23 [Suppl]: 4

    Google Scholar 

  19. Schlesinger-Raab A, Eckel R, Engel J et al. (2005) Metastasiertes Mammakarzinom: Keine Lebensverlängerung seit 20 Jahren. Dtsch Ärzteblatt 102(40): 2706–2714

    Google Scholar 

  20. Sledge GW (2005). What is targeted therapy ? J Clin Oncol 23(8): 1614–1615

    Article  PubMed  Google Scholar 

  21. Tannock IF, de Wit R, Berry WR et al. (2004) Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 351: 1502–1512

    Article  PubMed  Google Scholar 

  22. van der Maase H, Hansen SW, Roberts JT et al. (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 18: 3068–3077

    PubMed  Google Scholar 

  23. Winton T, Livingston R, Johnson D et al. (2005) Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 352: 2589–2597

    Article  PubMed  Google Scholar 

  24. 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 23 [Suppl]: 3500

    Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: M.-O. G., F.H. H. und R. A. waren bzw. sind als Investigator/Sub-Investigator an klinischen Studien mit Sorafenib (Konkurrenzprodukte: Sunitinib, GW786034), Docetaxel, Herceptin, Gemcitabine und Cisplatin beteiltig.

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Authors and Affiliations

  1. Urologische Klinik, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf

    M.-O. Grimm, F. H. Hartmann & R. Ackermann

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  1. M.-O. Grimm
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  2. F. H. Hartmann
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  3. R. Ackermann
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Correspondence to M.-O. Grimm.

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Grimm, MO., Hartmann, F.H. & Ackermann, R. Zukunft der Chemotherapie. Urologe 45, 567–571 (2006). https://doi.org/10.1007/s00120-006-1055-1

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