Metastasiertes Magenkarzinom: Ist eine Zweitlinien-Chemotherapie sinnvoll?

Zusammenfassung

Für die überwiegende Mehrzahl der Patienten mit Magenkarzinom ist die Therapie palliativ. Eine Vielzahl neuer Substanzen hat nachgewiesene Wirksamkeit beim Magenkarzinom. Eine Erstlinientherapie basierend auf Cisplatin/Fluoropyrimidin +/- Anthrazyklin oder +/- Docetaxel ist international etabliert. Der Einsatz einer Zweitlinientherapie variiert regional deutlich, was die Unsicherheit bezüglich des Nutzens der Therapie widerspiegelt. Beim ASCO 2009 wurde erstmalig eine Studie der deutschen AIO-Studiengruppe vorgestellt, die eine Überlebensverlängerung durch eine Zweitlinientherapie beim Magencarcinom im randomisierten Vergleich von Irinotecan mit Best Supportive Care gezeigt hat. Eine Zweilinientherapie sollte demnach jedem Patienten in gutem Allgemeinzustand und bei bestehendem Therapiewunsch angeboten werden. Phase-II-Daten zeigen Aktivität von Taxanen und Irinotecan als Mono- oder Kombinationstherapie mit Platinderivaten oder Fluoropyrimidinen. Nach Datenlage kann keine Substanz in der Zweilinientherapie einer anderen vorgezogen werden. Die Wahl sollte sich nach der Art der Vortherapie, dem Performance-Status des Patienten, dem Nebenwirkungsprofil und den Kontraindikationen einzelner Substanzen richten. Die Therapie mit biologischen Substanzen wie Everolimus oder Sunitinib wird aktuell in kontrollierten Studien untersucht.

Abstract

For the majority of patients with gastric cancer the aim of treatment is palliative. An increasing number of substances could prove activity in gastric cancer. A first-line regime based on cisplatin/ fluoropyrimidine +/- an anthracycline or +/- docetaxel is internationally accepted. The use of second-line chemotherapy varies dramatically between countries, reflecting the uncertainty of its benefit. At the ASCO conference 2009, the first randomized phase III study for second-line chemotherapy was presented by the German AIO group, which showed a significant prolongation of survival with second-line irinotecan compared to best supportive care. A second-line chemotherapy should therefore be discussed with every patient in good performance status. Phase II data show activity of second-line taxanes and irinotecan as monotherapy or combined with cisplatin or a fluoropyrimidin. The data does not show any regimen superior to another. The choice of second-line chemotherapy should depend on the pre-treatment, the performance status of the patient and contraindications of substances. Studies investigating new agents like everolimus and sunitinib are currently being conducted.

Schlüsselwörter

metastasiertes Magenkarzinom - Zweitlinien-Chemotherapie

Keywords

metastatic gastric cancer - second-line chemotherapy

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