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Z Gastroenterol 2018; 56(04): 384-397
DOI: 10.1055/s-0044-101757
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

ASCO- und ESMO-Update 2017 – Neuigkeiten vom 53. Meeting der American Society of Clinical Oncology/ASCO 2017 und European Society for Medical Oncology/ESMO-Congress 2017

ASCO- and ESMO-update 2017 – highlights of the 53. meeting of the American Society of Clinical Oncology/ASCO 2017 and European Society for Medical Oncology/ESMO congress 2017
Thomas J. Ettrich
1   Klinik für Innere Medizin, Universitätsklinikum Ulm, Ulm
,
Matthias Ebert
2   Medizinische Klinik des Universitätsklinikums Mannheim der Universität Heidelberg
,
Sylvie Lorenzen
3   Medizinische Klinik, Klinikum rechts der Isar, München
,
Markus Moehler
4   I. Medizinische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz
,
Arndt Vogel
5   Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover
,
Lukas Witkowski
6   Abteilung für Hämatologie, Onkologie und Palliativmedizin, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum
,
Thomas Seufferlein
1   Klinik für Innere Medizin, Universitätsklinikum Ulm, Ulm
,
Anke Reinacher-Schick
6   Abteilung für Hämatologie, Onkologie und Palliativmedizin, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum
› Author Affiliations
Further Information

Publication History

08 August 2017

23 January 2018

Publication Date:
11 April 2018 (online)

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Zusammenfassung

Auf dem Amerikanischen Krebskongress 2017 und dem Europäischen Krebskongress 2017 wurden eine Reihe von wichtigen Studien vorgestellt, die teilweise zu einer Änderung der aktuellen Therapiestandards in der Viszeralonkologie führen. So gilt nach den Ergebnissen der FLOT4-Studie die Kombination aus Docetaxel, Oxaliplatin und 5-Fluorouracil (FLOT) als der neue Behandlungsstandard in der perioperativen Therapie bei resektablen Adenokarzinomen des gastroösophagealen Übergangs und des Magens. Beim hepatozellulären Karzinom (HCC) hat die selektive interne Radiotherapie (SIRT) in zwei großen Studien keine Verbesserung des Überlebens gegenüber Sorafenib erbracht, sodass ein zunehmender Einsatz der SIRT nicht empfohlen wird. Hingegen scheint der Multityrosinkinase-Inhibitor Lenvatinib eine vielversprechende Alternative zu Sorafenib beim fortgeschrittenen HCC in der Erstlinientherapie zu sein. Beim frühen Kolonkarzinom kann nach den Daten der IDEA-Initiative bei Niedrigrisiko-Tumoren (T1 – 3, N1) nun eine dreimonatige Therapie mit Capecitabin und Oxaliplatin (CAPOX) empfohlen werden. Bei Hochrisikotumoren (T4 oder N2) soll weiterhin eine sechsmonatige Therapie mit 5-FU und Oxaliplatin (FOLFOX) oder CAPOX durchgeführt werden. Neben regelmäßiger Bewegung soll auch ein regelmäßiger Verzehr von Nüssen die Rezidivrate nach Resektion eines Kolonkarzinoms senken. Beim metastasierten kolorektalen Karzinom (mKRK) hat die SIRT in der Erstlinientherapie keinen Stellenwert. Beim BRAF-mutierten mKRK stellt die Kombination von Irinotecan, Cetuximab und Vemurafenib eine gute Therapiemöglichkeit in der Zweitlinientherapie dar. In der adjuvanten Therapie von Gallenwegstumoren stellt durch die positiven Ergebnisse der BILCAP-Studie die sechsmonatige Therapie mit Capecitabin den neuen Behandlungsstandard dar. Für das metastasierte Pankreaskarzinom kann möglicherweise der gezielte Angriff auf das Tumorstroma durch pegylierte Hyaluronidase PEGPH20 eine neue Therapieoption bieten, die derzeit in Phase-III-Studien überprüft wird.

Abstract

At ASCO 2017, and subsequently the ESMO congress 2017, a number of studies were presented which, in part, may change the present standard of therapy in gastrointestinal oncology. The German FLOT4 trial established perioperative Docetaxel, Oxaliplatin and 5-Fluorouracil (5-FU) as the new treatment standard for resectable adenocarcinoma of the gastroesophageal junction and the stomach. In hepatocellular carcinoma (HCC), two large studies did not show a survival benefit for selective internal therapy (SIRT), so an increasing use of SIRT in HCC is not recommended. On the other hand, the multityrosinekinase inhibitor Lenvatinib seems to be a promising alternative to sorafenib in first line treatment of metastatic HCC. In early colon cancer—following the data from the large IDEA initiative—three months of capecitabine and oxaliplatin is recommended for low-risk stage III cancers (T1 – 3, N1), while in high-risk stage III cancers (T4 or N2) patients should still receive six months of oxaliplatin and a fluoropyrimidine. Aside from regular exercise, one study found that regular intake of tree nuts (at least 2 servings per week), may decrease the risk of recurrence. In first line metastatic colorectal cancer (mCRC), SIRT should not be applied, whereas in BRAF mutant cancers, the combination of irinotecan, cetuximab and vemurafenib seems to be a promising second line treatment option. In biliary tract cancer, after curative resection, six months of capecitabine is considered the new treatment standard. Finally, in pancreatic cancer, targeting the tumor stroma with pegylated hyaluronidase (PEGPH20) may be a new treatment option that needs to be proven in phase 3 studies.

Schlüsselwörter

Ösophaguskarzinom - Magenkarzinom - kolorektales Karzinom - Pankreaskarzinom - Leberzellkarzinom - Gallenwegskarzinom - Targeted Therapies - klinische Studien - ASCO Meeting

Key words

esophageal cancer - gastric cancer - colorectal cancer - pancreatic cancer - hepatobiliary cancer - targeted therapies - clinical trials
 

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