Zusammenfassung
Die palliative Therapie des Pankreasadenokarzinoms besteht
aus Basistherapie (best supportive care/BSC), zu der insbesondere die Schmerz-
und
Ernährungstherapie gehört, sowie in einer palliativen antineoplastischen Therapie.
Ergänzt wird dies durch interventionell-therapeutische endoskopische Maßnahmen,
die den
Gallefluss wiederherstellen oder die Kontinuität des oberen Darmlumens durch die
Einlage von
Endoprothesen wahren. Die Schmerztherapie wird heute standardmäßig nach dem WHO-Schema
durchgeführt, während die Ernährungstherapie häufig vernachlässigt wird.
Für die palliative Chemotherapie empfiehlt sich entweder Gemcitabine oder 5-FU.
Kombinationen
mit anderen Zytostatika oder Bestrahlung befinden sich derzeit - im Rahmen von
Studien
- im Erprobungsstadium. Eine Reihe von rationalen Therapiekonzepten hat sehr gute
Ergebnisse
in tierexperimentellen und präklinischen Experimenten gezeigt, jedoch haben nur
wenige
Ansätze den Weg in frühe klinische Studien (Phase I/II) gefunden.
Palliative therapy of pancreatic carcinoma
The palliative therapy of
pancreatic carcinoma consists of best supportive care (BSC) including nutritional
and pain therapy,
and antineoplastic remedies. This is complemented by interventional endoscopy
aiming to treat
obstructive jaundice and/or gastric or duodenal obstruction by implantation of
endoprostheses. Pain
therapy is standardized for the most part according to the WHO guidelines; nutrition
of the cancer
patient, however, is sometimes disregarded. For palliative chemotherapy, 5-fluorouracil
and
gemcitabine can be recommended. Combinations thereof with other cytostatic drugs
or radiation are
subject to ongoing studies. A variety of novel therapeutic concepts, e. g. immunomodulation
or suicide gene therapy, have demonstrated good effects in animal studies. Unfortunately,
very few
of these have entered clinical studies (phase I and phase II). This will be the
focus of future
research in this field.
Schlüsselwörter
Pankreaskarzinom - Therapie - Chemotherapie - Gentherapie
Key words
Pancreatic
Carcinoma - Therapy - Review - Chemotherapy - Gene Therapy
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Anschrift für die Verfasser
Prof. Dr. med. J.-Matthias Löhr
Sektion Molekulare Gastroenterologie Medizinische Klinik IV
Fakultät für Klinische Medizin MannheimUniversität
Heidelberg
Theodor-Kutzer-Ufer
68135 Mannheim
Fax: 06 21/3 83 19 86
eMail: matthias.loehr@med4.ma.uni-heidelberg.de