Während ein lokal begrenzter Tumor durch eine chirurgische Therapie oder – in ausgewählten
Fällen – durch eine endoskopische Mukosaresektion optimal behandelt werden kann, liegt
bei den meisten Patienten entweder wegen eines lokal fortgeschrittenen Tumors oder
wegen Fernmetastasen ein Erkrankungsstadium vor, in dem eine kurative Resektion nicht
möglich ist. Dann ist neben palliativen chirurgischen oder endoskopischen Maßnahmen
eine systemische palliative Chemotherapie häufig die einzige Behandlungsoption. Basierend
auf den Ergebnissen zweier großer europäischer Studien gilt die perioperative Chemotherapie
mit dem Ziel der besseren lokalen Tumorkontrolle und der Therapie noch okkulter Fernmetastasen
in Europa heute als Standard. Während in der palliativen Situation bisher die Kombinationstherapie
mit Cisplatin und 5–Fluorouracil als Referenztherapie etabliert war, ist das Spektrum
der möglichen Therapieoptionen heute deutlich größer. Oxaliplatin und Capecitabin
sowie taxan– und irinotecanhaltige Schemata haben sich bei der Therapie des fortgeschrittenen
Magenkarzinoms als wirksam erwiesen. Die zusätzliche Behandlung mit Inhibitoren der
EGFR– und VEGF–Signalwege zeigt bislang in einarmigen Phase–II–Studien vielversprechende
Ergebnisse, sollte aber außerhalb von Studien nicht zum Einsatz kommen. Nicht zuletzt
bleibt aber eine optimale supportive Therapie von entscheidender Bedeutung.
In contrast to limited tumors that can be treated by surgical resection or – in well
selected cases – by endoscopic mucosectomy, most of the patients with gastric cancer
present either locally advanced stage or metastatic disease making curative resection
impossible. In these cases, a systemic palliative chemotherapy is often the only available
option for treatment besides palliative surgical or endoscopic techniques. Based on
results of two large–scale European studies, a perioperative chemotherapy is considered
as standard in Europe with respect to the aim of improved local tumor–control and
therapy of occult distant metastases. So far the use of combined therapy with cisplatin
and 5–FU was established as reference therapy, but the scale of palliative therapeutic
options has been widened recently. Oxaliplatin and capecitabine as well as taxanes
and irinotecan have been shown to be effective in the treatment of advanced gastric
cancer. An additional therapy with inhibitors of the EGFR– and VEGF–pathways has shown
promising results in early, single–armed studies, but should not be applied in a routine
clinical setting. An optimal supportive care remains the basis of treatment of patients
with advanced gastric cancer.
Key words
gastric cancer - locally advanced stage - metastatic disease - palliative chemotherapy
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Korrespondenz
Dr. Kerstin Schütte
Klinik für Gastroenterologie, Hepatologie und Infektiologie Otto–von–Guericke–Universität
Leipziger Straße 44
39120 Magdeburg
Email: kerstin.schuette@med.ovgu.de
