Onkologische Therapiekonzepte bei systemischer Metastasierung des kolorektalen Karzinoms

Zusammenfassung

Die onkologische Therapieführung des metastasierten Darmkrebs (mKRK) erfolgt in enger Kooperation mit anderen Fachdisziplinen, insbesondere der Chirurgie. Trotz Metastasierung können durch interdisziplinäre Behandlungen hier Langzeitverläufe ermöglicht werden, auch wenn die Erkrankung in der Mehrzahl der Fälle (unabhängig vom Behandlungspfad) nicht geheilt werden kann. Die rein onkologische Systemtherapie stützt sich derzeit vor allem auf Chemotherapiekombinationen und monoklonale Antikörper gegen VEGF (Vascular endothelial Growth Factor) und EGFR (Epidermal Growth Factor Receptor), die zu unterschiedlichen Regimen zusammengesetzt werden. Für die EGFR-Antikörper besteht mit den verschiedenen RAS-Mutationen ein negativer prädiktiver Biomarker, der aktuell durch die Beachtung der Primärtumorseite ergänzt wird. In späteren Therapielinien eröffnet sich derzeit die Möglichkeit einer personalisierten Therapie von Subgruppen. Hier sind insbesondere Patienten mit BRAF-V600E-Mutation (BRAF-inhibitorbasierte Kombinationen), Her2-positivem mKRK und Patienten mit MSI-H-Tumor (Checkpointinhibitoren) zu nennen.

Abstract

The successful management of metastatic colorectal cancer (mCRC) is an interdisciplinary challenge, involving medical oncology, surgery and also interventional specialists. Systemic therapy of mCRC is based on regimens of chemotherapeutic combinations plus monoclonal antibodies targeting EGFR and VEGF. EGFR-directed antibodies can guided by biomarkers, namely RAS mutation and sidedness of the primary tumor. In pretreated patients, several targetable molecular markers (i.e. BRAF mutation, MSI-status and Her2) should be tested. BRAF inhibitors, checkpoint-inhibitors and her2-targeted combinations (although off-label therapy) increase the available therapeutic options in these selected subgroups.

Schlüsselwörter

Darmkrebs - Systemtherapie - Chemotherapie

Key words

colorectal cancer - systemic therapy - chemotherapy

• Literatur

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