Palliative Chemotherapie beim kolorektalen Karzinom – Stand, Wertigkeit, Tendenzen

Zusammenfassung

Hintergrund: Es existiert eine Reihe von wirksamen Substanzen in der palliativen Behandlung kolorektaler Karzinome. Dadurch gelang es, die medianen Überlebenszeiten deutlich zu verlängern entweder rein medikamentös oder auch durch Erhöhung der sekundären Resektabilität bei erhöhter Wirksamkeit der applizierten Medikamente. Patienten / Material: Entscheidend für den Therapieerfolg bleibt die Festlegung der Therapieart in Abhängigkeit der vorherrschenden Patientencharateristik. Vorraussetzung ist hier eine interdisziplinäre Abstimmung innerhalb von Tumorboards. Methoden: Bei aggressiver Tumorsymptomatik wird ein Therapieansatz mit Induktion einer hohen Ansprechrate favorisiert. Dies beinhaltet in der Regel eine Drei- / Vierfach-Kombination mit Antikörpern. Bei langsamem Tumorprogress und eingeschränktem Patientenprofil wird eine sequenzielle Abfolge der Chemotherapie gewählt. Die Implementierung bzw. Einbindung von lokal ablativen Therapieverfahren in die Behandlungskonzepte ist eine zusätzliche Möglichkeit in der Effektivitätssteigerung. Im besten Falle können zusätzlich systemische Nebenwirkungseffekte vermieden werden, was mit einem nicht unerheblichen Benefit für die Lebensqualität einhergeht. Ergebnisse: Weitere Untersuchungen zur Genotypisierung neben dem K-RAS-Status sind notwendig, um prädiktive und prognostische Aussagen bezüglich der eingesetzten Wirkstoffe zu treffen und Wirkungslosigkeiten zu vermeiden. Schlussfolgerung: In der medikamentösen Therapie des metastasierten kolorektalen Karzinoms konnten in den letzten Jahren gute Fortschritte erzielt werden. Der zielgerichtete Einsatz der zur Verfügung stehenden sowie neueren Substanzen bedarf einer weiteren Evaluation innerhalb von Studien.

Abstract

Background: There are a number of effective substances available for palliative treatment of colorectal cancer, contributing to a considerable extension of the median survival time either purely medically or by increasing the chance of secondary resectability through improved effectiveness of the administered drugs. Patients / Material: Defining treatment depending on predominant patient characteristics remains crucial for any therapeutic success. This requires interdisciplinary co-ordination within tumour boards. Methods: In aggressive tumours a therapeutic approach inducing high response rates is favoured, usually including a triple or quadruple combination incl. antibodies. In cases of slow tumour progress and limited patient profile, a sequence of chemotherapy is chosen. Implementing and integrating locally ablative modes of therapy into the treatment strategy can increase the effectiveness additionally. In a best case scenario additional systemic side effects can be avoided resulting in a not insignificant benefit in quality of life. Results: Further genotyping beyond the K-RAS state is necessary to make predictive and prognostic statements concerning the drugs applied and to avoid ineffectiveness. Conclusion: Considerable progress has been achieved in the medical therapy for metastasised colorectal cancer. The targeted application of already available as well as recently developed substances requires further evaluation by appropriate studies.

Schlüsselwörter

kolorektales Karzinom - EGFR-Antikörper - VEGF-Antikörper - MSI - KRAS BRAF - Chemotherapie

Key words

colorectal cancer - EGFR antibodies - VEGF antibodies - MSI - KRAS BRAF - chemotherapy

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