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Adjuvante Therapie des kolorektalen Karzinoms

Vom Kaffee über Azetylsalizylsäure bis Chemotherapie

Adjuvant therapy of colorectal cancer

From coffee to acetylsalicylic acid to chemotherapy

  • Schwerpunkt
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Der Gastroenterologe Aims and scope

Zusammenfassung

Nach R0-Resektion eines Kolonkarzinoms im Stadium II und III soll die Indikation zur adjuvanten Therapie geprüft werden. Die Empfehlungen richten sich bislang nach klinischen und histopathologischen Kriterien. Neuerdings soll als erster molekularer Marker die hochgradige Mikrosatelliteninstabilität (MSI-H) bei der Therapieentscheidung im Stadium II einbezogen werden, immunonkologische Ansätze werden im Stadium III MSI‑H in Studien geprüft. Weitere molekulare Parameter, u. a. die zirkulierende Tumor-DNA (ctDNA), werden auf ihre prädiktive Wertigkeit hin aktuell getestet. Die Gruppe der älteren Patienten wird perspektivisch das größte Kollektiv darstellen und sollte zunehmend Beachtung finden.

Abstract

Adjuvant treatment should be considered in all patients with newly diagnosed resectable colon cancer stage II and III. Clinical and histopathological criteria are relevant for identifying patients who will most likely benefit from systemic treatment. Nowadays, defective mismatch repair or high microsatellite instability (MSI-H) should be tested before considering chemotherapy in stage II colon cancer. Targeted immune-oncologic therapies and predictive molecular markers, such as circulating tumor DNA (ctDNA), are currently being evaluated in clinical trials. The number of older patients with cancer will considerably increase over the next few years and will require greater attention in clinical trials and guidelines.

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  1. Abteilung für Hämatologie, Onkologie und Palliativmedizin, St. Josef-Hospital Bochum Klinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland

    A.-L. Kraeft &  A. Reinacher-Schick

  2. Medizinische Klinik 1, Universitätsklinikum Dresden, Dresden, Deutschland

    G. Folprecht

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A.-L. Kraeft erhielt finanzielle Unterstützung von der Firma Celgene, A. Reinacher-Schick erhielt Honoria/persönliche Honorare für Vorträge von den Firmen Amgen, AstraZeneca, BMS, Celgene, Lilly, Merck Serono, MSD, Pfizer, Roche, Sanofi-Aventis und Servier. Sie ist Mitglied im Advisory Board der Firmen Amgen, AstraZeneca, Baxalta, BMS, Celgene, Merck Serono, MSD, Pierre Fabre, Pfizer, Roche, Sanofi-Aventis und Servier. Ferner erhielt sie Reisekostenfinanzierungen von den Firmen Amgen, AstraZeneca, Celgene, Ipsen, Merck Serono, MSD, Pierre Fabre, Roche und Servier, Studienunterstützung von den Firmen Roche und Ipsen sowie eine Finanzierung ihrer wissenschaftlichen Untersuchungen (Studien und Forschung) von den Firmen Amgen, Astra Zeneca, Celgene, Ipsen, Lilly, Roche, Servier und Mologen Berlin. G. Folprecht erhielt finanzielle Unterstützung von den Firmen Bristol-Myers Squibb, Eli Lilly/ImClone, Merck KGaA, Merck & Co., Roche/Genentech, Sanofi/Aventis und Servier. Er war als Berater für die Firmen Amgen, Bayer, Bristol-Myers Squibb, Merck KGaA, Merck & Co., Mundipharma GmbH, Roche/Genentech, Sanofi/Aventis und Servier tätig. Ferner erhielt er eine Unterstützung seiner wissenschaftlichen Arbeit von der Firma Merck KGaA.

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Kraeft, AL., Reinacher-Schick, A. & Folprecht, G. Adjuvante Therapie des kolorektalen Karzinoms. Gastroenterologe 15, 290–299 (2020). https://doi.org/10.1007/s11377-020-00453-8

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