Zusammenfassung
Die Prognose des Ösophaguskarzinoms ist unbefriedigend und korreliert eng mit dem Stadium; ein möglichst exaktes prätherapeutisches Staging ist für die individuelle Therapiestrategie prognoserelevant. Am häufigsten kommen Adenokarzinome und Plattenepithelkarzinome vor. Perioperative multimodale onkologische Therapiekonzepte haben zur deutlichen Verbesserung des Behandlungserfolgs in den potenziell kurativ resektablen Stadien geführt. Bei der chirurgischen Therapie ist eine weitgehende Standardisierung und Spezialisierung erfolgt. Minimal-invasive Operationstechniken wurden verfeinert und haben die Patientenbelastung gemeinsam mit umfassenden perioperativen Behandlungskonzepten und verbessertem Komplikationsmanagement vermindert und die Patientensicherheit erhöht. Die Daten der Studien mit Immuncheckpointinhibitoren zeigen seit vielen Jahren erstmals einen Fortschritt in der Therapie in dieser Entität. Pembrolizumab plus platinhaltige Chemotherapie ist somit neuer Standard of Care beim Plattenepithelkarzinom (PEC); die Resultate sind unabhängig von PD-L1-Status („programmed death-ligand 1“), bei erhaltener Lebensqualität. Die Zugabe von Nivolumab zur Chemotherapie ist der neue Standard in der Erstlinientherapie des Adenokarzinoms des Magens/GEJ („gastroesophageal junction“) und CPS (Combined-positive-Score) ≥ 5. Im adjuvanten Setting sind die Immuncheckpointinhibitoren ebenfalls angekommen. Die adjuvante Therapie mit Nivolumab führt zu einer statistisch signifikanten und klinisch relevanten Verlängerung der krankheitsfreien Überlebenszeit. Die Zulassung von Nivolumab in der adjuvanten Situation, zumindest für das PEC, wird erwartet.
Abstract
The prognosis of esophageal cancer is limited and closely correlated with the stage; thus, precise pretherapeutic staging is relevant for the individual treatment strategy and prognosis. Most frequent malignancies are adenocarcinoma and squamous cell carcinoma. Perioperative multimodal treatment strategies have remarkably contributed to a substantial improvement in the outcome of surgery. Surgery itself has undergone extensive standardization and specialization. Minimally invasive procedures have been refined and have led to decreased patient surgical burden. Enhanced recovery strategies and improved complication management enhanced perioperative patient safety and reduced failure to rescue. Data from studies with immune checkpoint inhibitors show, for the first time in many years, an advance in therapy in this entity. Pembrolizumab plus platinum-containing chemotherapy is the new standard of care for squamous cell carcinoma (SCC); the results are independent of programmed death ligand 1 (PD-L1) status, while quality of life is maintained. The addition of nivolumab to chemotherapy is the new standard in the first-line treatment of gastric adenocarcinoma/GEJ(gastroesophageal junction) and CPS(Combined-positive score) ≥ 5. The immune checkpoint inhibitors have also arrived in the adjuvant setting. Adjuvant treatment with nivolumab leads to a statistically significant and clinically relevant extension of disease-free survival. The approval of nivolumab as adjuvant treatment, at least for the SCC, is expected.
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U. Pluschnig: Consultant or Advisory Role: Roche, Eli Lilly, Daiichi Sankyo; Speaking: Roche. J. Zacherl gibt an, dass kein Interessenkonflikt besteht.
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Pluschnig, U., Zacherl, J. Interdisziplinäre Therapiekonzepte beim Ösophaguskarzinom. J. Gastroenterol. Hepatol. Erkr. 19, 26–33 (2021). https://doi.org/10.1007/s41971-021-00099-5
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DOI: https://doi.org/10.1007/s41971-021-00099-5
Schlüsselwörter
- Perioperative multimodale Therapiekonzepte
- Ösophagusresektion
- Minimal-invasive Chirurgie
- Checkpointinhibition
- Practice-changing
- Adjuvante Therapie