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Chemotherapie des metastasierten kolorektalen Karzinoms

Chemotherapy of metastatic colorectal cancer

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Zusammenfassung

Zur systemischen Therapie des metastasierten kolorektalen Karzinoms (mKRK) stehen zunehmend mehr Optionen zur Verfügung, die eine sorgfältige Therapieplanung bereits vor Therapiestart notwendig machen. Die Wahl der Erstlinientherapie richtet sich nach klinischen und molekularpathologischen Parametern, z. B. nach Mutationen der (K-)RAS-Gene bezüglich der Therapiesteuerung von Epidermal-growth-factor-receptor(EGFR)-Antikörpern. Die Erstlinientherapie beeinflusst alle weiteren therapeutischen Entscheidungen und kann daher als Weichenstellung bezeichnet werden. Kombinationen aus Chemotherapie und Biologika sind derzeit der Therapiestandard. Dabei mehren sich in der Erstlinientherapie die Hinweise, dass Patienten mit (K-)RAS-Wildtyp-Tumoren hinsichtlich des Gesamtüberlebens von einer primären Anti-EGFR-Therapie mehr als von einer Anti-vascular-endothelial-growth-factor(VEGF)-Strategie profitieren. Die Entwicklung wirkungsvoller Therapiestrategien für Patienten mit (K-)RAS-mutiertem mKRK – das sind etwa 50 % aller Patienten – muss in der Zukunft vorangetrieben werden, da die therapeutischen Optionen für diese Gruppe von Patienten deutlich limitiert sind.

Abstract

Increasing numbers of therapeutic options are becoming available for the systemic treatment of metastasized colorectal cancer (mCRC) which emphasizes the need for strategic decision making and planning across multiple lines of treatment. The choice of first-line therapy is influenced by clinical and molecular characteristics of patients and tumors, such as (K-)RAS gene mutations with respect to therapy guidance of epidermal growth factor receptor (EGFR) antibodies. First-line therapy is the major determinant of subsequent treatment regimens and can therefore be considered as the key decision in patients with mCRC. The German standard for first-line therapy in the majority of patients includes chemotherapy in combination with biological agents, with antibodies targeting EGFR possibly being the preferable option in patients with (K-)RAS wild-type tumors. The development of effective therapeutic strategies in patients with (K-)RAS mutant mCRC tumors must be promoted in the future and requires intensive research because the therapy options for this group of patients are very limited.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D.P. Modest: Forschungsunterstützung, Reiseunterstützung und Vortragshonorare: Amgen, Merck Serono und Roche. W. Hiddemann gibt an, dass kein Interessenkonflikt besteht. V. Heinemann: Forschungsunterstützung, Reiseunterstützung, Vortragshonorare und Beratungstätigkeit: Amgen, Merck Serono, Roche, Sanofi-Aventis. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Medizinische Klinik und Poliklinik III & Comprehensive Cancer Center, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland

    D.P. Modest, W. Hiddemann &  V. Heinemann

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  1. D.P. Modest
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  2. W. Hiddemann
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  3. V. Heinemann
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Correspondence to D.P. Modest.

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Modest, D., Hiddemann, W. & Heinemann, V. Chemotherapie des metastasierten kolorektalen Karzinoms. Internist 55, 37–42 (2014). https://doi.org/10.1007/s00108-013-3314-8

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