Allgemein- und Viszeralchirurgie up2date, Inhaltsverzeichnis Allgemein- und Viszeralchirurgie up2date 2017; 11(01): 67-80DOI: 10.1055/s-0042-120308 Oberer Gastrointestinaltrakt Georg Thieme Verlag KG Stuttgart · New York Therapiekonzepte beim metastasierten Magenkarzinom Thorsten O. Götze , Lars M. Schiffmann , Salah-Eddin Al-Batran , Stefan P. Mönig Artikel empfehlen Abstract Artikel einzeln kaufen Alle Artikel dieser Rubrik Die Chirurgie stellt die Behandlung der Wahl beim Magenkarzinom dar. Eine Systemtherapie prä- und/oder postoperativ kann die Heilungsraten verbessern. Für viele Patienten ist jedoch eine Heilung aufgrund des fortgeschrittenen Tumorstadiums nicht mehr möglich. In dieser palliativen Situation steht die Abwägung von Therapienutzen und Nebenwirkungen im Vordergrund; die Ziele sind Verlängerung der Lebenszeit und die Verbesserung der Lebensqualität. Volltext Referenzen Literatur 1 Higuchi K, Tanabe S, Shimada K. et al. Biweekly irinotecan plus cisplatin versus irinotecan alone as second-line treatment for advanced gastric cancer: a randomised phase III trial (TCOG GI-0801/BIRIP trial). Eur J Cancer 2014; 50: 1437-1445 2 Janjigian YY, Riches JC, Ku GY. et al. Loss of human epidermal growth factor receptor 2 (HER2) expression in HER2-overexpressing esophagogastric (EG) tumors treated with trastuzumab. ASCO Meeting Abstr 2015; 33: 63 3 Janjigian YY, Werner D, Pauligk C. et al. Prognosis of metastatic gastric and gastroesophageal junction cancer by HER2 status: a European and USA International collaborative analysis. Ann Oncol 2012; 23: 2656-2662 4 Jeurnink SM, Steyerberg EW, van Hooft JE. et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71: 490-499 5 Glimelius B, Ekström K, Hoffman K. et al. Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol 1997; 8: 163-168 6 Findlay M, Cunningham D, Norman A. et al. A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in combination with continuous infusion 5-fluorouracil (ECF). Ann Oncol 1994; 5: 609-616 7 Kim R, Nishimoto N, Inoue H. et al. An analysis of the therapeutic efficacy of protracted infusion of low-dose 5-fluorouracil and cisplatin in advanced gastric cancer. J Infect Chemother 2000; 6: 222-228 8 Al-Batran SE, Ajani JA. Impact of chemotherapy on quality of life in patients with metastatic esophagogastric cancer. Cancer 2010; 116: 2511-2518 9 Kaatsch P, Spix C, Katalinic A. et al. Krebs in Deutschland 2007/2008. Berlin: Robert Koch-Institut; 2012 10 Al-Batran SE, Hartmann JT, Hofheinz R. et al. Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol 2008; 19: 1882-1887 11 Bang YJ, 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 2012; 376: 687-697 12 Dank M, Zaluski J, Barone C. et al. Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic acid to cisplatin combined with 5-fluorouracil in chemotherapy naive patients with advanced adenocarcinoma of the stomach or esophagogastric junction. Ann Oncol 2008; 19: 1450-1457 13 Kang YK, Kang WK, Shin DB. et al. Capecitabine/cisplatin versus 5-fluorouracil/cisplatin as first-line therapy in patients with advanced gastric cancer: a randomised phase III noninferiority trial. Ann Oncol 2009; 20: 666-673 14 Van Cutsem E, Kang Y, Chung H, Shen L. Efficacy results from the ToGA trial: a phase III study of trastuzumab added to standard chemotherapy in first-line HER2-positive advanced gastric cancer. Proc ASCO 2009: Suppl-Abstr LBA4509. 15 Kang Y-K, Shah MA, Ohtsu A. et al. A randomized, open-label, multicenter, adaptive phase 2/3 study of trastuzumab emtansine (T-DM1) versus a taxane (TAX) in patients (pts) with previously treated HER2-positive locally advanced or metastatic gastric/gastroesophageal junction adenocarcinoma (LA/MGC/GEJC). J Clin Oncol 2016; 34 (Suppl. 04) Abstr. 5 16 Satoh T, Xu RH, Chung HC. et al. Lapatinib plus paclitaxel versus paclitaxel alone in the second-line treatment of HER2-amplified advanced gastric cancer in Asian populations: TyTAN–a randomized, phase III study. J Clin Oncol 2014; 32: 2039-2049 17 Van Cutsem E, Moiseyenko VM, Tjulandin S. et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 2006; 24: 4991-4997 18 Wagner AD, Moehler M. Development of targeted therapies in advanced gastric cancer: promising exploratory steps in a new era. Curr Opin Oncol 2009; 21: 381-385 19 Wagner AD, Unverzagt S, Grothe W. et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 2010; (03) CD004064 20 Bouché O, Raoul JL, Bonnetain F. et al. Fédération Francophone de Cancérologie Digestive Group. Randomized multicenter phase II trial of a biweekly regimen of fluorouracil and leucovorin (LV5FU2), LV5FU2 plus cisplatin, or LV5FU2 plus irinotecan in patients with previously untreated metastatic gastric cancer: a Federation Francophone de Cancerologie Digestive Group Study-FFCD 9803. J Clin Oncol 2004; 22: 4319-4328 21 Tebbutt NC, Norman A, Cunningham D. et al. A multicentre, randomised phase III trial comparing protracted venous infusion (PVI) 5-fluorouracil (5-FU) with PVI 5-FU plus mitomycin C in patients with inoperable oesophago-gastric cancer. Ann Oncol 2002; 13: 1568-1575 22 Fahlke J, Ridwelski K, Schmidt C. et al. A multicentre phase II study of docetaxel plus cisplatin for the treatment of advanced gastric cancer. Chemotherapy 2007; 53: 454-460 23 Thuss-Patience PC, Kretzschmar A, Repp M. et al. Docetaxel and continuous-infusion fluorouracil versus epirubicin, cisplatin, and fluorouracil for advanced gastric adenocarcinoma: a randomized phase II study. J Clin Oncol 2005; 23: 494-501 24 Cunningham D, Okines AFC, Ashley S. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 2010; 362: 858-859 25 Moehler M, Al-Batran SE, Andus T. et al. S3-Leitlinie „Magenkarzinom“ — Diagnostik und Therapie der Adenokarzinome des Magens und ösophagogastralen Übergangs. AWMF Registernummer 032-009OL. Z Gastroenterol 2011; 49: 461-531 http://www.awmf.org/leitlinien/detail/ll/032.009OL.html 26 Moehler M, Eimermacher A, Siebler J. et al. Randomised phase II evaluation of irinotecan plus high-dose 5-fluorouracil and leucovorin (ILF) vs. 5-fluorouracil, leucovorin, and etoposide (ELF) in untreated metastatic gastric cancer. Br J Cancer 2005; 92: 2122-2128 27 Moehler M, Kanzler S, Geissler M. et al. A randomized multicenter phase II study comparing capecitabine with irinotecan or cisplatin in metastatic adenocarcinoma of the stomach or esophagogastric junction. Ann Oncol 2009; 21: 71-77 28 Thuss-Patience PC, Kretzschmar A, Deist T. et al. Irinotecan versus best supportive care (BSC) as second-line therapy in gastric cancer: A randomized phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). ASCO Meeting Abstr 2009; 27: 4540 29 Shin D, Lee S, Park S. et al. Randomized phase II trial of irinotecan, leucovorin and 5-fluorouracil (ILF) versus cisplatin plus ILF (PILF) for advanced gastric cancer. ASCO Meeting Abstr 2007; 25: 4580 30 Assersohn L, Brown G, Cunningham D. et al. Phase II study of irinotecan and 5-fluorouracil/leucovorin in patients with primary refractory or relapsed advanced oesophageal and gastric carcinoma. Ann Oncol 2004; 15: 64-69 31 Rosati G, Bilancia D, Germano D. et al. Reduced dose intensity of docetaxel plus capecitabine as second-line palliative chemotherapy in patients with metastatic gastric cancer: a phase II study. Ann Oncol 2007; 18 Suppl 6: vi128-132 32 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 33 Miranda MB, Hartmann JT, Al-Batran SE. et al. Mitomycin C and capecitabine in pretreated patients with metastatic gastric cancer: a multicenter phase II study. J Cancer Res Clin Oncol 2014; 140: 829-837 34 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 35 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 36 Lordick F. Gastrointestinal cancer: Over the RAINBOW – renaissance in antiangiogenesis. Nat Rev Clin Oncol 2014; 12: 7-8 37 Hallissey MT, Allum WH, Roginski C. et al. Palliative surgery for gastric cancer. Cancer 1988; 62: 440-444 38 Hartgrink HH, Putter H, Klein Kranenbarg E. et al. Value of palliative resection in gastric cancer. Br J Surg 2002; 89: 1438-1443 39 Kulig P, Sierzega M, Kowalczyk T. et al. Non-curative gastrectomy for metastatic gastric cancer: rationale and long-term outcome in multicenter settings. Eur J Surg Oncol 2012; 38: 490-496 40 Meyer HJ, Hölscher AH, Lordick F. et al. Aktuelle S3-Leitlinie zur Chirurgie des Magenkarzinoms. Chirurg 2012; 83: 31-37 41 Lasithiotakis K, Antoniou SA, Antoniou GA. et al. Gastrectomy for stage IV gastric cancer. a systematic review and meta-analysis. Anticancer Res 2014; 34: 2079-2085 42 Thrumurthy SG, Chaudry MA, Chau I. et al. Does surgery have a role in managing incurable gastric cancer?. Nat Rev Clin Oncol 2015; 12: 676-682 43 Mahar AL, Coburn NG, Singh S. et al. A systematic review of surgery for non-curative gastric cancer. Gastric Cancer 2011; 15: 125-137 44 He MM, Zhang DS, Wang F. et al. The role of non-curative surgery in incurable, asymptomatic advanced gastric cancer. PLoS One 2013; 8: e83921 45 Samarasam I, Chandran BS, Sitaram V. et al. Palliative gastrectomy in Advanced gastric cancer: is it worthwhile?. ANZ J Surg 2006; 76: 60-63 46 Mariette C, Bruyère E, Messager M. et al. FREGAT Working Group. Palliative resection for advanced gastric and junctional adenocarcinoma: which patients will benefit from surgery?. Ann Surg Oncol 2013; 20: 1240-1249 47 Mahar AL, Coburn NG, Karanicolas PJ. et al. Effective palliation and quality of life outcomes in studies of surgery for advanced, non-curative gastric cancer: a systematic review. Gastric Cancer 2011; 15: 138-145 48 Yang HK, Tsujinaka T, Nakamura K. et al. Randomized controlled trial of comparing gastrectomy (Gx) plus chemotherapy (CTX) with CTX alone in advanced gastric cancer (AGC) with a single non-curable factor: JCOG 0705/KGCA01 study (REGATTA). J Clin Oncol 2015; 33: No15 Supp 49 Al-Batran S-E, Hofheinz R, Homann N. et al. A prospective trial for defining a subset of patients with limited metastatic gastric cancer who may be candidates for bimodal treatment strategies: FLOT3. J Clin Oncol 2012; 30 (Suppl) Abstr. 4090