Aktuelle Therapiemöglichkeiten des kolorektalen Karzinoms

Zusammenfassung

Das kolorektale Karzinom ist in den industrialisierten Ländern eine der Hauptursachen der tumorbedingten Sterblichkeit. Obwohl bei 70 - 80% der Patienten eine kurative Resektion möglich ist, liegt die 5-Jahres-Überlebensrate aller Stadien nur bei 50 - 60%. In den letzten 10 Jahren konnte durch intensive klinische Forschung der Stellenwert der adjuvanten Therapie des kolorektalen Karzinoms etabliert und systematisch weiterentwickelt werden. Durch die Anwendung neuer Chemotherapeutika aus der Gruppe der Topoisomeraseinhibitoren (Irinotecan) und der Platinderivate (Oxaliplatin) konnte sowohl in der palliativen als auch in der adjuvanten Therapie eine deutliche Verbesserung der Ergebnisse erzielt werden. In der palliativen Therapie lassen sich heute durch die sequentielle Anwendung der neuen Kombinationstherapien Überlenbenszeiten von mehr als 20 Monaten erreichen. Auch die gezielte Beeeinflussung molekularbiologischer Tumormechanismen durch neue Substanzen wie z. B. monoklonale Antikörper gegen den Epidermalen Wachstumsfaktorrezeptor oder den Vascular Endothelial Growth Factor, zeigt beeindruckende Erfolge. Neben der erfreulichen Verbesserung der Behandlungsergebnisse hat die Einführung der genannten Substanzen jedoch auch zu einer gesteigerten Komplexität hinsichtlich der Therapie-Auswahl, Planung und Umsetzung geführt. In der vorliegenden Arbeit soll ein Überblick über die aktuellen Behandlungsstrategien und deren Stellenwert in der systemischen Chemotherapie des kolorektalen Karzinoms gegeben werden.

Abstract

Colorectal Cancer is one of the leading causes for cancer related death in the industrialized world. The 5 year overall survival is only 50 - 60 %, although 70 - 80% of the patients are potentially cured by surgical resection. During the last 10 years intensive clinical studies helped to establish the value of adjuvant therapy for colorectal cancer. The introduction of new chemotherapeutic agents like Irinotecan and Oxaliplatin, has led to a significant increase in tumor response and median survival in patients with colorectal carcinoma receiving adjuvant or palliative chemotherapy. In the later situation the sequential application of new combination therapies enables an overall survival of exceeding more than 20 month. In addition the targeted manipulation of molecular tumor mechanisms with new substances like monoclonal antibodies against the epidermal growth factor receptor or the vascular endothelial growth factor shows promising effects. Besides the encouraging improvement of treatment results the introduction of the new drugs has also led to more complexity within choice, strategy and conduction of specific therapies. This manuscript introduces actual treatment concepts and their impact on colorectal cancer.

Kolorektales Karzinom - Chemotherapie - Pathogenese

Colorectal cancer - chemotherapy - pathogenesis

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