Dtsch Med Wochenschr 2007; 132(15): 818-822
DOI: 10.1055/s-2007-973627
Aktuelle Diagnostik & Therapie | Review article
Onkologie
© Georg Thieme Verlag KG Stuttgart · New York

Molekular-basierte Therapiekonzepte beim fortgeschrittenen Pankreaskarzinom

Molecular-based treatment concepts in advanced pancreatic cancerS. Boeck1 , N. Moosmann1 , H.-J Stemmler1 , V. Heinemann1
  • 1Medizinische Klinik und Poliklinik III, Klinikum der Universität München - Großhadern
Further Information

Publication History

eingereicht: 24.11.2006

akzeptiert: 27.2.2007

Publication Date:
11 April 2007 (online)

Zusammenfassung

Seit der Zulassung des Nukleosidanalogons Gemcitabin gilt dieses Zytostatikum als eine Standardtherapie für Patienten mit fortgeschrittenem Pankreaskarzinom. Nachdem mehrere Studien zur einer Gemcitabin-basierten Kombinationschemotherapie keinen relevanten Überlebensvorteil gegenüber der Gemcitabin-Monotherapie zeigen konnten, rücken in letzter Zeit auch beim Pankreaskarzinom molekulare Therapieansätze - basierend auf neuen Erkenntnissen der Tumorbiologie - zunehmend ins wissenschaftliche und auch klinische Interesse. Die vorliegende Übersichtsarbeit gibt einen kurzen Überblick zu diese aktuellen Studienergebnisse und zudem einen Ausblick über neue molekular-basierte Therapiekonzepte beim fortgeschrittenen Pankreaskarzinom.

Summary

Since the approval of the nucleoside analogue gemcitabine, this cytotoxic drug is regarded as a standard of care for patients with advanced pancreatic cancer. After several clinical trials evaluating gemcitabine-based combination chemotherapy have failed to demonstrate a significant survival benefit compared to single-agent gemcitabine, molecular-targeted treatment regimens for pancreatic cancer - based on new knowledge in tumor biology - are an increasing focus of scientific as well as clinical interest. This review gives a short overview of recent data from clinical trials and summarizes future perspectives of new molecular-based treatment strategies for advanced pancreatic cancer.

Literatur

  • 1 Asahina A, Yamazaki K, Kinoshita I. et al . A phase II trial of gefitinib as first-line therapy for advanced non-small cell lung cancer with epidermal growth factor receptor mutations.  Br J Cancer. 2006;  95 998-1004
  • 2 Bruns C J, Harbison M T, Davis D W. et al . Epidermal growth factor receptor blockade with C225 plus gemcitabine results in regression of human pancreatic carcinoma growing orthotopically in nude mice by antiangiogenetic mechanisms.  Clin Cancer Res. 2000;  6 1936-1948
  • 3 Bramhall S R, Rosemurgy A, Brown P D. et al . Marimastat as first-line therapy for patients with unresectable pancreatic cancer: a randomized trial.  J Clin Oncol. 2001;  19 3447-3455
  • 4 Bramhall S R, Schulz J, Nemunaitis J. et al . A double-blind placebo-controlled, randomised study comparing gemcitabine and marimastat with gemcitabine and placebo as first line therapy in patients with advanced pancreatic cancer.  Br J Cancer. 2002;  87 161-167
  • 5 Burris H A, Moore M J, Andersen J. et al . Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: A randomized trial.  J Clin Oncol. 1997;  15 2403-2413
  • 6 Cunningham D, Humblet Y, Siena S. et al . Cetuximab monotherapy and cetuximab plus irinotecan in iriotecan-refractory metastatic colorectal cancer.  N Engl J Med. 2004;  351 337-345
  • 7 De Gramont A, van Cutsem E. Investigating the potential of bevacizumab in other indications: metastatic renal cell, non-small cell lung, pancreatic and breast cancer.  Oncology. 2005;  69 46-56
  • 8 Hochster H S, Haller D G, de Gramont A. et al . Consensus report of the international society of gastrointestinal oncology on therapeutic progress in advanced pancreatic cancer.  Cancer. 2006;  107 676-685
  • 9 Hurwitz H, Fehrenbacher L, Novotny W. et al . Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer.  N Engl J Med. 2004;  350 2335-2342
  • 10 Javle M M, Iyer R V, Yu J. et al . Phase II study of gemcitabine, capecitabine and bevacizumab for advanced pancreatic cancer (APC) with ECOG PS 0 - 1 (abstract).  Proc Am Soc Clin Oncol. 2006;  24 4117
  • 11 Karayiannakis A J, Bolanaki H, Syrigos K N. et al . Serum vascular endothelial growth factor levels in pancreatic cancer patients correlate with advanced and metastatic disease and poor prognosis.  Cancer Lett. 2003;  194 119-124
  • 12 Kim G P, Oberg A, Kabat B. et al . NCCTG phase II trial of bevacizumab, gemcitabine and oxaliplatin in patients with metastatic pancreatic adenocarcinoma (abstract).  Proc Am Soc Clin Oncol. 2006;  24 4113
  • 13 Kindler H L, Bylow K A, Hochster H S. et al . A randomized phase II study of bevacizumab (B) and gemcitabine (G) puls cetuximab (C) or erlotinib (E) in patients (pts) with advanced pancreatic cancer (PC): a preliminary analysis (abstract).  Proc Am Soc Clin Oncol. 2006;  24 4040
  • 14 Kindler H L, Friberg G, Singh D A. et al . Phase II trial of bevacizumab plus gemcitabine in patients with advanced pancreatic cancer.  J Clin Oncol. 2005;  23 8033-8040
  • 15 Kindler H L, Niedzwiecki D, Hollis D. et al . A double-blind, placebo-controlled, randomized phase III trial of gemcitabine (G) plus bevacizumab (B) versus gemcitabine plus placebo (P) in patients (pts) with advanced pancreatic cancer (PC): A preliminary analysis of Cancer and Leukemia Group B (CALGB) 80 303 (abstract).  Proc Gastrointestinal Cancers Symposium. 2007;  139 108
  • 16 Ko A H, Dito E, Schillinger B. et al . A phase II study of gemcitabine (GEM) given at fixed-dose rate (FDR) infusion, low-dose cisplatin (CDDP), and bevacizumab in metastatic pancreatic cancer (PanCa) (abstract).  Proc Am Soc Clin Oncol. 2006;  24 4041
  • 17 Moore M J, Goldstein D, Hamm J. et al . Erlotinib plus gemcitabine compared to gemcitabine alone in patients with advanced pancreatic cancer. A phase III trial of the National Cancer Institute of Canada Clinical Trials Group [NCIC-CTG] (abstract).  Proc Am Soc Clin Oncol. 2005;  23 1
  • 18 Moore M J, Hamm J, Dancey J. et al . Comparison of gemcitabine vesus the matrix metalloproteinase inhibitor BAY 12 - 9566 in patients with advanced or metastatic adenocarcinoma of the pancreas: A phase III trial of the National Cancer Institute of Canada Clinical Trials Group.  J Clin Oncol. 2003;  21 3296-3302
  • 19 Seo Y, Baba H, Fukuda T. et al . High expression of vascular endothelial growth factor is associated with liver metastasis and a poor prognosis for patients with ductal pancreatic adenocarcinoma.  Cancer. 2000;  88 2239-2245
  • 20 Ueda S, Ogata S, Tsuda H. et al . The correlation between cytoplasmatic overexpression of epidermal growth factor receptor and tumor aggressiveness: poor prognosis in patients with pancreatic ductal adenocarcinoma.  Pancreas. 2004;  29 1-8
  • 21 Van Cutsem E, van de Velde H, Karasek P. et al . Phase III trial of gemcitabine plus tipifarnib compared with gemcitabine plus placebo in advanced pancreatic cancer.  J Clin Oncol. 2004;  22 1430-1438
  • 22 Xiong H Q, Rosenberg A, LoBuglio A. et al . Cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor, in combination with gemcitabine for advanced pancreatic cancer: A multicenter phase II trial.  J Clin Oncol. 2004;  22 2610-2616

Dr. med. Stefan Boeck

Medizinische Klinik und Poliklinik III, Klinikum der Universität München - Großhadern

Marchioninistraße 15

81377 München

Phone: 089/70952208

Fax: 089/70955256

Email: stefan.boeck@med.uni-muenchen.de

    >