Kernaussagen
Behandlungsstrategien
Die Einführung der neuen Chemotherapeutika Irinotecan und Oxaliplatin hat neben einer Verbesserung der Behandlungsergebnisse auch eine Zunahme der therapeutischen Komplexität mit sich gebracht, welche zwingend die enge interdisziplinäre Zusammenarbeit der beteiligten Fachdisziplinen erfordert.
Die systemische Behandlung des kolorektalen Karzinoms verfolgt 3 zentrale Ziele: die Prävention des Rezidivs nach kurativer Resektion (adjuvante Therapie), die Lebensverlängerung und Symptomkontrolle bei Patienten mit metastasierter Erkrankung (palliative Therapie) und das erreichen einer sekundären kurativen Resektabilität oder die Verlängerung des rezidivfreien Überlebens durch eine präoperative Behandlung (neoadjuvante Therapie).
Adjuvante Therapie des KRK
Oxaliplatin ist dem Irinotecan in der adjuvanten Therapie überlegen, weshalb außerhalb von Studien FOLFOX4/6 die Standardtherapie im Stadium III darstellt.
Ist eine Kombinationschemotherapie nicht möglich, sollte Capecitabin eingesetzt werden. Zielgerichtete biologische Substanzen sollten derzeit nur in Studien zum Einsatz kommen.
Bei Patienten im Stadium II kann bei Hochrisikokonstellation (Perforation, Ileus, T4, G3, V1 oder weniger als 10 entnommene Lymphknoten) eine adjuvante Therapie erwogen werden.
Systemische Therapie des fortgeschrittenen KRK
Ein wirklicher therapeutischer Fortschritt im Bereich der palliativen Therapie konnte mit der Einführung der neuen Chemotherapeutika Irinotecan und Oxaliplatin sowie der neuen biologischen Wirkstoffe Cetuximab und Bevacizumab erzielt werden.
Nicht welche Kombinationschemotherapie als Erstlinientherapie verabreicht wird, bestimmt die Prognose des Patienten, sondern ob der Patient während seines Krankheitsverlaufs alle zur Verfügung stehenden aktiven Substanzen erhält.
„Stopp-and-Go-Strategien” können die Nebenwirkungen reduzieren und damit die Lebensqualität der Patienten während der Chemotherapie verbessern.
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Prof. Dr. Wolff Schmiegel
Medizinische Universitätsklinik
Knappschaftskrankenhaus Bochum · In der Schornau 23-25 · 44892 Bochum
Email: wolff.schmiegel@rub.de
