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Risikoadaptierte adjuvante Therapie des Kolonkarzinoms

Risk-adapted adjuvant treatment of colon cancer

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Der Gastroenterologe Aims and scope

Zusammenfassung

Die adjuvante Therapie von Patienten mit einem Kolonkarzinom erfolgt gemäß bestimmten Risikogruppen. Im UICC-Stadium III ist die adjuvante Therapie mit einer oxaliplatinhaltigen Chemotherapie (Folfox oder Capox) indiziert (Empfehlungsgrad A). Bei Patienten, die keine Kombinationschemotherapie erhalten können, sollte Capecitabin als Monosubstanz eingesetzt werden. Bei Patienten im Stadium II entscheiden weiterhin die bekannten klinischen und pathologischen Risikofaktoren wie T4-Kategorie, zu wenige untersuchte Lymphknoten, Notfalloperation oder Tumoreinriss/-perforation über die Indikation für eine adjuvante Chemotherapie. Liegen solche Risikofaktoren vor, so sollte eine adjuvante Therapie mit einem Fluoropyrimidin eingeleitet werden. Keiner dieser Risikofaktoren ist bislang prospektiv validiert. Oxaliplatin hat im Stadium II keinen Stellenwert, da der absolute Überlebensbenefit gering ist. Für Patienten ohne klinische Risikofaktoren besteht eine „Kann“-Empfehlung für eine adjuvante Therapie auf dem Boden der QUASAR-Studie. Die US-amerikanischen Empfehlungen sehen hingegen keine Indikation für eine adjuvante Therapie im Stadium II ohne Risikofaktoren.

Abstract

Adjuvant treatment of colon cancer is recommended according to the initial UICC stage of the disease and certain risk factors. If lymph nodes are afflicted (UICC stage III) combination chemotherapy with oxaliplatin and fluoropyrimidines (5-FU or capecitabine) should be administered (evidence level 1a, recommendation level A) following data from the French MOSAIC study. If patients do not qualify for combination treatment monotherapy with fluoropyrimidines should be given preferably with capecitabine. In UICC stage II cancer the recommendation for adjuvant therapy depends on the presence of certain risk factors such as T4 category, emergency surgery, perforation and insufficient lymph nodes examined (less than 12), and patients should then receive adjuvant chemotherapy with fluoropyrimidines. However, none of these risk factors have been validated prospectively and the predictive value is unclear. Oxaliplatin should not be added in stage II cancer. If patients are diagnosed with stage II cancer without risk factors then fluoropyrimidines may be given according to the results of the QUASAR study. In contrast, the ASCO guidelines do not recommend chemotherapy for stage II patients without risk factors.

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Interessenskonflikt

Die Autorin weist auf folgende Beziehungen hin: Honoraria von Amgen, Roche, Pfizer, Sanofi-Aventis; Advisory-Board-Teilnahme bei Amgen, Roche, Pfizer und Merck; Unterstützung für Studien und Forschungsprojekte von Roche und Sanofi-Aventis.

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  1. Medizinische Universitätsklinik, Knappschaftskrankenhaus, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deuschland

    A. Reinacher-Schick

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Correspondence to A. Reinacher-Schick.

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Reinacher-Schick, A. Risikoadaptierte adjuvante Therapie des Kolonkarzinoms. Gastroenterologe 7, 14–23 (2012). https://doi.org/10.1007/s11377-011-0606-1

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