Zusammenfassung
Die Behandlung des metastasierten kolorektalen Karzinoms (mCRC) hat sich in den letzten Jahren noch einmal deutlich verbessert. Große Fortschritte betreffen vor allem Biomarker wie RAS, MSI oder BRAF, deren Kenntnis zunehmend wichtiger wird für die Auswahl und Planung von Erstlinientherapie und Behandlungssequenz. Durch die Berücksichtigung von Biomarkern lässt sich die Behandlung des mCRC im Hinblick auf Wirksamkeit und Nebenwirkungen besser dem individuellen Patienten anpassen.
Literatur
Brenner H et al. Expected long-term impact of the German screening colonoscopy programme on colorectal cancer prevention: analyses based on 4,407,971 screening colonoscopies. Eur J Cancer. 2015;51(10):1346–53.
O’Connell JB et al. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst. 2004;96(19):1420–5.
Heinemann V et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15(10):1065–75.
Venook AP et al. CALGB/SWOG 80405: Phase III trial of irinotecan/5-FU/leucovorin (FOLFIRI) or oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab (BV) or cetuximab (CET) for patients (pts) with KRAS wild-type (wt) untreated metastatic adenocarcinoma of the colon or rectum (MCRC). J Clin Oncol 2014;32(Suppl, 5s):Abstr LBA3.
Tournigand C et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22(2):229–37.
Loree JM et al. Retrospective comparison of CAPOX and FOLFOX dose intensity, toxicity, and clinical outcomes in the treatment of metastatic colon cancer. J Gastrointest Cancer. 2014;45(2):154–60.
Mayer RJ et al. Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med. 2015;372(20):1909–19.
Stintzing S et al. Predictive and prognostic markers in the treatment of metastatic colorectal cancer (mCRC): personalized medicine at work. Hematol Oncol Clin North Am. 2015;29(1):43–60.
Hurwitz H et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350(23): 2335–42.
Saltz LB et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008;26(12):2013–9.
Giantonio BJ et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol. 2007;25(12):1539–44.
Cunningham D et al. Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): an open-label, randomised phase 3 trial. Lancet Oncol. 2013;14(11):1077–85.
Douillard JY et al. Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer. N Engl J Med. 2013;369(11):1023–34.
Van Cutsem E et al. Fluorouracil, leucovorin, and irinotecan plus cetuximab treatment and RAS mutations in colorectal cancer. J Clin Oncol. 2015;33(7):692–700.
Bibeau F et al. Impact of Fc{gamma}RIIa-Fc{gamma}RIIIa polymorphisms and KRAS mutations on the clinical outcome of patients with metastatic colorectal cancer treated with cetuximab plus irinotecan. J Clin Oncol. 2009;27(7):1122–9.
Lièvre A et al. KRAS mutation status is predictive of response to cetuximab therapy in colorectal cancer. Cancer Res. 2006;66(8):3992–5.
Jung A et al. Controlling the quality of RAS mutation testing by a dichotomous approach: Ring trials and benchmarking mutation frequencies by a RAS monitor. J Clin Oncol 2015;33(Suppl, 3s):Abstr 536.
Schmoll HJ et al. Effect of adjuvant capecitabine or fluorouracil, with or without oxaliplatin, on survival outcomes in stage III colon cancer and the effect of oxaliplatin on post-relapse survival: a pooled analysis of individual patient data from four randomised controlled trials. Lancet Oncol. 2014;15(13):1481–92.
Tejpar S et al. Microsatellite instability, prognosis and drug sensitivity of stage II and III colorectal cancer: more complexity to the puzzle. J Natl Cancer Inst. 2011;103(11):841–4.
Sauer R et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012};30(16):1926–33.
Rodel C et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol. 2012;13(7):679–87.
Hong YS et al. Oxaliplatin, fluorouracil, and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy (ADORE): an open-label, multicentre, phase 2, randomised controlled trial. Lancet Oncol. 2014;15(11):1245–53.
Hofheinz RD et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012;13(6):579–88.
Abrams TA et al. Chemotherapy usage patterns in a US-wide cohort of patients with metastatic colorectal cancer. J Natl Cancer Inst. 2014;106(2):djt371.
Douillard JY et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet. 2000;355(9209):1041–7.
Saltz LB et al. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med. 2000;343(13):905–14.
Schwartzberg LS et al. PEAK: a randomized, multicenter phase II study of panitumumab plus modified fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) or bevacizumab plus mFOLFOX6 in patients with previously untreated, unresectable, wild-type KRAS exon 2 metastatic colorectal cancer. J Clin Oncol. 2014;32(21):2240–7.
Stintzing S et al. Independent radiological evaluation of objective response, early tumor shrinkage, and depth of response in FIRE-3 (AIO KRK-0306) in the final RAS evaluable population. Ann Oncol. 2014;25(5s):v1–v41.
Lenz HJ et al. CALGB/SWOG 80405: Phase III trial of irinotecan/5-FU/leucovorin (FOLFIRI) or oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab (BV) or cetuximab (CET) for patients (pts) with expanded RAS analyses untreated metastatic adenocarcinoma of the colon or rectum (mCRC). Ann Oncol. 2014;25(5s): v1–v41.
Khattak MA et al. Role of first-line anti-epidermal growth factor receptor therapy compared with anti-vascular endothelial growth factor therapy in advanced colorectal cancer: a meta-analysis of randomized clinical trials. Clin Colorectal Cancer. 2015;14(2):81–90.
Loupakis et al. Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N Engl J Med. 2014;371(17):1609–18.
Author information
Authors and Affiliations
Corresponding author
Additional information
Interessenkonflikte
PD Dr. med. Sebastian Stintzing gibt Vortragshonorare von Merck-Serono, Roche, Amgen, Sanofi, Bayer sowie Reisekostenerstattungen durch Merck-Serono, Roche, Amgen, Sanofi, Bayer an. Er ist zudem in Beiräten für Merck-Serono, Roche, Amgen, Sanofi, Bayer tätig. Prof. Dr. med. Volker Heinemann gibt Vortragshonorare und Forschungsunterstützung von Merck, Roche, Amgen, Sanofi an. Er ist zudem in Beiräten für Merck-Serono, Roche, Amgen, Sanofi tätig.
Der Verlag erklärt, dass die inhaltliche Qualität des Beitrags von zwei unabhängigen Gutachtern geprüft wurde. Werbung in dieser Zeitschriftenausgabe hat keinen Bezug zur CME-Fortbildung. Der Verlag garantiert, dass die CME-Fortbildung sowie die CME-Fragen frei sind von werblichen Aussagen und keinerlei Produktempfehlungen enthalten. Dies gilt insbesondere für Präparate, die zur Therapie des dargestellten Krankheitsbildes geeignet sind.
Rights and permissions
About this article
Cite this article
Stintzing, S., Heinemann, V. Wahl der Behandlungsstrategie auf der Basis molekularer Marker. Im Focus Onkologie 18, 51–59 (2015). https://doi.org/10.1007/s15015-015-1827-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15015-015-1827-9