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Palliative endoscopic and chemotherapeutic treatment

Palliative endoskopische und chemotherapeutische Behandlung

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Zusammenfassung

GRUNDLAGEN: Das kolorektale Karzinom (KRK) ist die zweithäufigste krebsbedingte Todesursache in der westlichen Welt. Das Ziel der palliativen Therapie ist die Überlebensverlängerung und Verbesserung der Lebensqualität. METHODIK: Die Beschreibung der Therapieoptionen basiert auf einer systematischen Literatursuche und auf den Empfehlungen der aktuellen S3 Leitlinie zur Behandlung des metastasierten KRK. ERGEBNISSE: Ein Darmverschluss durch gastrointestinale Tumorobstruktion kann in der palliativen Situation durch die endoskopische Einlage von selbstexpandierenden Metallstents behandelt werden. Die systemische palliative Behandlung ist durch die Einführung neuer, effektiver Chemotherapeutika entscheidend verbessert worden. SCHLUSSFOLGERUNGEN: Bei tumorbedingten Symptomen oder Progress der Erkrankung ist eine intensive Kombinationschemotherapie indiziert. Durch den Einsatz von zielgerichteten Substanzen wird eine Verbesserung des Überlebens erreicht. Vor Kurzem wurde mit dem Mutationsstatus des KRAS-Onkogens ein erster prädiktiver molekularer Marker in die klinische Praxis eingeführt, was einen entscheidenden ersten Schritt hin zu einer Individualisierung der Therapie darstellt.

Summary

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer death in the western world. The aim of palliative therapy is the prolongation of survival and the improvement of quality of life. METHODS: The description of therapeutic options is based on systematically literature search and on the German S3 guideline for metastatic CRC treatment. RESULTS: In the case of gastrointestinal tumour obstruction, endoscopic self-expanding metal stents (SEMS) insertion is a non-surgery palliative treatment option. New and effective chemotherapeutic substances and biologics have improved the systemic treatment of patients with mCRC in the past decade. CONCLUSIONS: Endoscopic or intensive combination chemotherapy is indicated if the patient suffers from tumour symptoms or disease progression. Combination therapy with monoclonal antibodies leads to further improvement of survival. The introduction of the mutational status examination of the KRAS oncogene as the first predictive marker into clinical care is an important step towards the individualization of treatment.

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Abbreviations

5-FU:

5-fluorouracil

ASCO:

American association of Oncology

AIO:

Arbeitsgemeinschaft internistische Onkologie

BSC:

Best supportive care

BICC:

"Bolus, Infusional or Capecitabine with Camptosar-Celecoxib" trial

BRAF:

Humanes Onkogen: V-raf murine sarcoma viral oncogene homolog B1

CAIRO:

"CApecitabine IRinotecan, Oxaliplatin" trial

CRC:

Colorectal cancer

CRYSTAL:

"Cetuximab combined with iRinotecan in first line therapY for metaSTatic colorectAL cancer" trial

egfr:

Epidermal growth factor receptor

GI:

Gastrointestinal

IGF:

Insulin-like growth factor-1

IHC:

Immunohistochemistry

KRAS:

Kirsten rat sarcoma viral homolog Oncogen

LV:

Leukovorin

mCRC:

Metastatic colorectal cancer

mab:

Monoclonal antibody

mTOR:

Mammalian Target of Rapamycin

OS:

Overall survival

PFS:

Progression-free-survival

QoL:

Quality of life

SEMS:

Self-expanding metal stent

vegf:

Vascular endothelial growth factor

vs.:

versus

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Authors and Affiliations

  1. Department of Medicine, Knappschaftskrankenhaus, Ruhr University, Bochum, Germany

    M. Pohl, A. Reinacher-Schick & W. Schmiegel

  2. Center for Clinical Oncological Studies within P.U.R.E., Ruhr University, Bochum, Germany

    A. Reinacher-Schick & W. Schmiegel

  3. Department of Gastroenterology and Hepatology, BG University Clinics Bergmannsheil, Ruhr University, Bochum, Germany

    W. Schmiegel

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  1. M. Pohl
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Correspondence to A. Reinacher-Schick.

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Pohl, M., Reinacher-Schick, A. & Schmiegel, W. Palliative endoscopic and chemotherapeutic treatment. Eur Surg 42, 287–298 (2010). https://doi.org/10.1007/s10353-010-0571-9

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