Möglichkeiten der Response-Prädiktion neoadjuvanter und adjuvanter Therapien beim Ösophagus- und Magenkarzinom

Zusammenfassung

Das Ösophagus- und Magenkarzinom stellen weltweit zwei der Haupttodesursachen durch maligne Erkrankungen dar. Dazu ist das Adenokarzinom der Speiseröhre aktuell die schnellst ansteigende bösartige Grunderkrankung in den westlichen Ländern. Da diese Tumorformen zumeist in einem fortgeschrittenen Stadium diagnostiziert werden, ist häufig ein multimodales Therapieprozedere erforderlich. Trotz großer Fortschritte sowohl der Operationstechniken als auch neoadjuvanter/adjuvanter Behandlungsstrategien, profitieren nur ca. 20 % der Patienten mit einem fortgeschrittenen Ösophaguskarzinom von einer neoadjuvanten Therapie. Aus diesem Grund ist es notwendig prädiktive/prognostische Faktoren zu etablieren, die ein individuelles Behandlungskonzept ermöglichen. Mittels innovativer, molekularbiologischer Techniken ist es jedoch in den letzten Jahren gelungen, Marker zu beschreiben, die eine Response-Prädiktion neoadjuvanter und adjuvanter Therapien beim Ösophagus- und Magenkarzinom zulassen. Dabei wurden verschiedenartige Faktoren beschrieben, wie z. B. angiogenetische Faktoren, Enzyme involviert in DNS-Reparaturmechansimen, Faktoren des 5-Fluorouracil-Metabolismus, Tumorsuppressorgene oder Wachstumsfaktor-Rezeptoren. Die zumeist retrospektiv erzielten Studienergebnisse sind Erfolg versprechend, müssen aber in prospektiven Studien validiert werden.

Abstract

Esophageal and gastric carcinomas constitute a major cause of cancer deaths worldwide and esophageal adenocarcinoma is currently the most rapidly increasing cancer in the Western world. These tumors are usually detected at an advanced stage, requiring a multimodal concept. Despite improvements in surgical techniques as well as neoadjuvant/adjuvant therapies, for example less than 20 % of the patients with advanced esophageal cancer benefit from neoadjuvant therapy. Therefore predictive/prognostic markers are necessary to achieve an individual management concerning (radio-) chemotherapy and increase efficacy. Recently molecular markers have been identified using innovative, molecularbiological technologies to predict response to neoadjuvant and adjuvant therapies in esophageal and gastric cancer. These factors are enzymes of angiogenesis, enzymes involved in the DNA-repair-system, factors of the 5-fluorouracil metabolism, tumorsupressor genes or growth-factor receptors. These markers found mainly in retrospective studies are prom-ising but prospective studies are needed to validate these mark-ers.

Ösophagus-/Magenkarzinom - Response-Prädiktion - molekulare Faktoren

Esophageal/gastric cancer - response prediction - molecular factors

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