Aktuelle Standards in der Therapie des Magenkarzinoms

Zusammenfassung

Während Magenfrühkarzinome endoskopisch reseziert werden können, stellt die Gastrektomie mit D2 Lymphadenektomie den Standard für die lokal weiter fortgeschrittenen Stadien dar. Eine perioperative Chemotherapie verbessert das Überleben beim lokal fortgeschrittenen Magenkarzinom. Eine neoadjuvante Radiochemotherapie ist für die Adenokarzinome des ösophago-gastralen Übergangs eine gut etablierte Alternative zur perioperativen Chemotherapie. Im metastasierten Stadium verbessert eine Chemotherapie das Überleben, die Lebensqualität und Symptomkontrolle. Bei HER2 positiven Tumoren sollte Trastuzumab in die Erstlinien-Systemtherapie integriert werden. Eine Zweit- und Drittlinientherapie ist mittlerweile ebenfalls gut etabliert. Der anti-VEGFR2 Antikörper Ramucirumab ist in der Zweitlinientherapie alleine und in Kombination mit Paclitaxel wirksam und stellt eine neue Behandlungsoption dar.

Abstract

Endoscopic resection is established in the treatment of early gastric cancer. More advanced gastric cancer requires gastrectomy and D2 lymphadenectomy. Perioperative chemotherapy improves overall survival in locally advanced gastric cancer representing a standard of care. Locally advanced adenocarcinomas of the esophago-gastric junction can alternatively be treated with concurrent radiochemotherapy. In metastatic disease, systemic chemotherapy improves survival, quality of life and symptom control. Trastuzumab plus chemotherapy should be used together with first-line chemotherapy in HER2 positive gastric cancer patients. Second- and third-line therapy is now well established. The anti-VEGFR2 antibody Ramucirumab improves survival in second line treatment both as a monotherapy and in combination with paclitaxel and represents a novel treatment option.

Schlüsselwörter

Magenkarzinom - multimodale Therapie - Chemotherapie

Keywords

gastric cancer - multimodal treatment - chemotherapy

• Literatur

• 1 Songun I, Putter H, Kranenbarg EM et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010; 11: 439-449
• 2 Chen K, Xu XW, Mou YP et al. Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer. World J Surg Oncol 2013; 11: 182
• 3 Ychou M, Boige V, Pignon JP et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 2011; 29: 1715-1721
• 4 Cunningham D, Allum WH, Stenning SP et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20
• 5 Moehler M, Al-Batran SE, Andus T et al. German S3-guideline “Diagnosis and treatment of esophagogastric cancer”. Z Gastroenterol 2011; 49: 461-531
• 6 van Hagen P, Hulshof MC, van Lanschot JJ et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366: 2074-2084
• 7 Paoletti X, Oba K, Burzykowski T et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA 2010; 303: 1729-1737
• 8 Bang YJ, Kim YW, Yang HK et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 2012; 379: 315-321
• 9 Lordick F, Lorenzen S, Yamada Y, Ilson D. Optimal chemotherapy for advanced gastric cancer: is there a global consensus?. Gastric Cancer 2014; 17: 213-225
• 10 Bang Y-J, Van Cutsem E, Feyereislova A et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376: 687-697
• 11 Lordick F, Kang Y-K, Chung H-C et al. Capecitabine and cisplatin with or without cetuximab for patients with previously untreated advanced gastric cancer (EXPAND): a randomised, open-label phase 3 trial. Lancet Oncol 2013; 14: 490-499
• 12 Waddell T, Chau I, Cunningham D et al. Epirubicin, oxaliplatin, and capecitabine with or without panitumumab for patients with previously untreated advanced oesophagogastric cancer (REAL3): a randomised, open-label phase 3 trial. Lancet Oncol 2013; 14: 481-489
• 13 Ohtsu A, Shah MA, Van Cutsem E et al. Bevacizumab in combination with chemotherapy as first-line therapy in advanced gastric cancer: a randomized, double-blind, placebo-controlled phase III study. J Clin Oncol 2011; 29: 3968-3976
• 14 Fuchs CS, Tomasek J, Yong CJ et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 2014; 383: 31-39
• 15 Wilke H, Muro K, Van Cutsem E et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol 2014; 15: 1224-1235
• 16 Lordick F, Gockel I, Wittekind C. Magenkarzinom: Neue molekulare Konzepte. Dtsch Aerztebl 2015;
• 17 Thuss-Patience PC, Kretzschmar A, Bichev D et al. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer – a randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Eur J Cancer 2011; 47: 2306-2314
• 18 Kang JH, Lee SI, Lim do H et al. Salvage Chemotherapy for Pretreated Gastric Cancer: A Randomized Phase III Trial Comparing Chemotherapy Plus Best Supportive Care With Best Supportive Care Alone. J Clin Oncol 2012; 30: 1513-1518
• 19 Hironaka S, Ueda S, Yasui H et al. Randomized, Open-Label, Phase III Study Comparing Irinotecan With Paclitaxel in Patients With Advanced Gastric Cancer Without Severe Peritoneal Metastasis After Failure of Prior Combination Chemotherapy Using Fluoropyrimidine Plus Platinum: WJOG 4007 Trial. J Clin Oncol 2013; 31: 4438-4444
• 20 Ford HE, Marshall A, Bridgewater JA et al. Docetaxel versus active symptom control for refractory oesophagogastric adenocarcinoma (COUGAR-02): an open-label, phase 3 randomised controlled trial. Lancet Oncol 2014; 15: 78-86