Adjuvante Therapie des Pankreaskarzinoms

Zusammenfassung

Die komplette (R0) Resektion gefolgt von einer adjuvanten Chemotherapie verbessert signifikant die Prognose von Patienten mit einem Adenokarzinom des Pankreas. Zu diesem Ergebnis kommt eine randomisiert-kontrollierte klinische Studie (RCT) zur adjuvanten Therapie des Pankreaskarzinoms, die ESPAC-1 (European Study Group for Pancreatic Cancer) Studie, eine Meta-Analyse von 5 RCTs zur adjuvanten Therapie, sowie eine erst kürzlich veröffentlichte Studie (RCT) zur adjuvanten Chemotherapie des Pankreaskarzinoms. Sowohl 5-FU als auch Gemcitabin scheinen als adjuvante Therapie effektiv zu sein, und die bald abgeschlossene ESPAC-3 Studie wird zeigen, ob es einen Vorteil für eines der beiden Chemotherapeutika gibt. Eine adjuvante/additive Radiochemotherapie scheint -wenn überhaupt- nur einen möglichen Vorteil bei mikroskopisch nicht kompletter (R1) Resektion zu haben; dies muss sich jedoch erst in RCTs bestätigen, d. h. eine adjuvante Radiochemotherapie sowie adjuvante Kombinations-Chemotherapien sollten nur im Rahmen von klinischen Studien angewendet werden.

Summary

Curative (R0) resection and subsequent adjuvant chemotherapy increases significantly the prognosis of patients suffering from adenocarcinoma of the pancreas. This statement is substantiated by the ESPAC-1 (European Study Group for Pancreatic Cancer) trial, a meta-analysis of 5 RCTs for adjuvant therapy as well as a recent RCT for adjuvant chemotherapy in pancreatic cancer. 5-FU and Gemcitabin seem to be effective in the adjuvant setting, and the ESPAC-3 trial will determine which (if any) chemotherapy is superior. Adjuvant/additive chemoradiation might have its role in a subgroup of patients with positive resection margins (R1), however, this has to be proven in RCTs. Thus, adjuvant chemoradiation and/or adjuvant combination therapies should only be used within clinical trials.

Schlüsselwörter

Pankreaskarzinom - adjuvante Chemotherapie - adjuvante Radiochemotherapie - neoadjuvante Therapie

Key words

pancreatic cancer - adjuvant chemotherapy - adjuvant chemoradiation - neoadjuvant therapy

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