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KRAS und weitere Signalmoleküle für die Therapieentscheidung beim metastasierten Kolonkarzinom

K-ras and other signal molecules for therapy decision-making in metastasized colorectal cancer

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Der Gastroenterologe Aims and scope

Zusammenfassung

Die „zielgerichtete Therapie“ hat in den letzten Jahren in die gesamte Onkologie Einzug gehalten, insbesondere auch in die Behandlung des kolorektalen Karzinoms. Diese Entwicklung ist das Ergebnis von zunehmendem Wissen über Signalkaskaden in Tumoren in vitro und in vivo, die eine wesentliche Rolle bei der Regulation von Zellüberleben, Tumorwachstum und Metastasierung spielen. Dies führte zur Entwicklung von Strategien, tumorrelevante Signalkaskaden selektiv zu unterbrechen und idealerweise mit zielgerichteten Medikamenten nur den Tumor, nicht aber andere Organe oder Zellsysteme zu treffen. Im Bereich des kolorektalen Karzinoms hat nicht zuletzt die Einführung von zielgerichteten Therapien eine deutlichen Verbesserung von Tumoransprechen, progressionsfreiem Überleben und Gesamtüberleben gebracht – allerdings nicht für alle Patienten, die mit diesen Medikamenten behandelt werden. Es stellt sich also zunehmend die Frage nach prädiktiven Markern für eine Therapie mit diesen – auch kostenintensiven – Therapeutika, die eine Vorhersage erlauben, ob ein Patient von einer bestimmten zielgerichteten Therapie profitieren wird. Im vorliegenden Beitrag wird der aktuelle Stand und Stellenwert prädiktiver Marker für zielgerichtete Therapiestrategien gegen den epidermalen Wachstumsfaktorrezeptor beim metastasierten kolorektalen Karzinom dargestellt.

Abstract

In recent years targeted therapy has made an impact in all aspects of oncology but in particular in the treatment of colorectal cancer. This development is the result of increasing knowledge on signal cascades in tumors in vitro and in vivo which play an essential role in the regulation of cell survival, tumor growth and metastasis. This has led to the development of strategies to interrupt signal cascades relevant for tumors and ideally with targeted medications to affect only the tumor and not other organs or cell systems. In the field of colorectal cancer the implementation of targeted therapies has if nothing else brought a clear improvement in tumor response, progression-free survival and total survival; however, not for all patients treated with these medications. There is therefore an increasing demand for predictive markers for therapy with these, even cost-intensive, therapeutics which allow a prediction whether a patient will profit from a certain targeted therapy. In this article the current state of the art and value of predictive markers for targeted therapy strategies against epidermal growth factor receptor for metastasized colorectal cancer will be presented.

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Interessenkonflikt

Der Autor weist auf folgende Beziehung hin: Übernahme der Reisekosten zum ASCO GI Cancer Symposium 2011 durch Merck Serono.

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  1. Klinik für Innere Medizin I, Universitätsklinikum, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 01620, Halle, Deutschland

    T.J. Ettrich

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Ettrich, T. KRAS und weitere Signalmoleküle für die Therapieentscheidung beim metastasierten Kolonkarzinom. Gastroenterologe 7, 24–29 (2012). https://doi.org/10.1007/s11377-011-0607-0

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