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TumorDiagnostik & Therapie 2014; 35(5): 268-273
DOI: 10.1055/s-0034-1369212
Schwerpunkt: Gastrointestinale Stromatumoren
Georg Thieme Verlag KG Stuttgart · New York

Übersicht – Therapie gastrointestinaler Stromatumoren

K. Heißner
,
H.-G. Kopp
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Publication History

Publication Date:
19 August 2014 (online)

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Die Therapie gastrointestinaler Stromatumoren (GIST) ist einer der ersten Erfolge der Medizin auf dem Gebiet der zielgerichteten molekularen Medizin. Die Erkenntnis, dass onkogene Mutationen der Rezeptor-Tyrosinkinase c-KIT und PDGFRα zum malignen Wachstum der Cajal-Zellen führt und durch den Einsatz selektiver Tyrosinkinaseinhibitoren (TKI) effektiv gehemmt werden kann, stellte einen der ersten Meilensteine auf dem Weg zu einer individualisierten Krebstherapie dar. Heute sind wir in der Lage anhand radiologischer, histologischer und molekularbiologischer Kriterien die Notwendigkeit einer adjuvanten Therapie nach kompletter Resektion abschätzen zu können. Zudem sind bestimmte Mutationen auch prädiktiv hinsichtlich Ansprechen und Dosis von TKI.

Im Fall primär metastasierter oder rezidivierter GIST lag das mediane Überleben von Patienten vor der Aufklärung des molekularen Pathomechanismus bei 10–20 Monaten [1]. Seit der Verfügbarkeit von TKIs konnte das mediane Überleben auf 51–57 Monate verlängert werden [2],[3]. Auf der diesjährigen ASCO-Jahrestagung wurden Langzeitüberlebensdaten von Studienpatienten in palliativer Situation unter Therapie mit Tyrosinkinaseinhibitoren publiziert [4]. Die Nachbeobachtung von 695 Patienten dokumentiert ein Überleben in 26% und 22% der Patienten nach 8 bzw. 10 Jahren.

Gerade die Möglichkeit zur Einleitung einer individualisierten Therapie auf Basis multidisziplinärer Befunde unterstreicht den Stellenwert der gemeinsamen Diskussion der Patienten im Rahmen von Tumorboards.

 

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