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DOI: 10.1055/s-0029-1243961
© Georg Thieme Verlag KG Stuttgart · New York
Medikamentöse Therapie des kolorektalen Karzinoms
Publication History
Publication Date:
22 March 2010 (online)
![](https://www.thieme-connect.de/media/gastroenterologie-u2d/201001/lookinside/thumbnails/10.1055-s-0029-1243961-1.jpg)
Kernaussagen
Adjuvante Therapie
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Im Stadium II sollten Patienten bei Hochrisikokonstellation eine adjuvante Therapie mit einem Fluoropyrimidin erhalten. Bei Patienten ohne Risikofaktoren kann eine adjuvante Therapie mit einem Fluoropyrimidin erfolgen.
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Eine FOLFOX-Therapie über 6 Monate ist therapeutischer Standard im Stadium III (mit Lymphknotenbefall).
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Patienten über 70 Jahre sollten Kombinationstherapien zurückhaltend erhalten.
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Bei Kontraindikationen für eine Kombinationschemotherapie mit Oxaliplatin sollte Capecitabin gegeben werden.
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Irinotecan und monoklonale Antikörper haben keinen Stellenwert in der adjuvanten Therapie.
Therapie im Stadium IV
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Patienten mit Lebermetastasierung (potenziell kurative Therapie) werden nach klinischem Status unterschieden von nicht resektablen Patienten (palliative Therapie).
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Der k-ras-Mutationsstatus ist ein negativer prädiktiver Faktor für eine Anti-EGFR-Antikörpertherapie. Bei Patienten im Stadium IV mit der Möglichkeit einer Kombinationstherapie sollte der k-ras-Mutationsstatus untersucht werden.
Gruppe 1: Patienten mit primär resektabler Lebermetastasierung:
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Bei primär resektabler Lebermetastasierung kann eine perioperative Chemotherapie durchgeführt werden (prä- und postoperative oder postoperative Therapie).
Gruppe 2.1: Patienten mit primär nicht resektablen Lebermetastasen, bei denen nach intensiver Kombinationstherapie die Möglichkeit für eine Resektion besteht:
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Eine intensive Kombinationstherapie aus drei Substanzen sollte eingesetzt werden (Konversionstherapie).
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Sobald die Erkrankung resektabel erscheint, sollte der Patient operiert werden. Die Hepatotoxizität durch eine präoperative Therapie ist zu berücksichtigen.
Gruppe 2.2: Patienten ohne Möglichkeit einer Resektion mit tumorbedingten Symptomen, Organkomplikationen oder raschem Progress:
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Bei Erstdiagnose ist eine möglichst intensive Kombinationstherapie indiziert.
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Eine Kombinationschemotherapie mit monoklonalen Antikörpern verbessert das Überleben, steigert jedoch auch die Kosten und vergrößert den Überlebensvorteil nur moderat.
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Therapiedeeskalation und Erhaltungstherapien sind bei gleicher Wirksamkeit und verbesserter Lebensqualität durch Reduktion von Toxizitäten möglich.
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Eine optimale Therapiesequenz gibt es nicht. Entscheidend ist der Einsatz aller wirksamen Substanzen im Erkrankungsverlauf.
Gruppe 3: Patienten mit multiplen Metastasen ohne Option für eine Resektion nach Metastasenrückbildung, ohne tumorbezogene Symptome oder Organkomplikationen und/oder mit schwerer Komorbidität:
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Eine Monotherapie kann mit 5-FU begonnen werden und ggf. mit Bevacizumab kombiniert werden.
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Prof. Dr. Wolff Schmiegel
Medizinische Universitätsklinik
Knappschaftskrankenhaus Bochum
In der Schornau 23 – 25
44892 Bochum
Email: meduni-kkh@rub.de