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Neoadjuvante Chemotherapie beim Magenkarzinom. Vielfach eine Übertherapie oder ein sinnvolles Konzept?

Neoadjuvant chemotherapy for gastric cancer. Frequent overtreatment or meaningful concept?

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Zusammenfassung

Die neoadjuvante/perioperative Therapie mit radikaler Chirurgie ist ein sinnvoller Ansatz zur Verbesserung der Prognose beim Magenkarzinom. Als perioperatives Konzept hat sich in Deutschland und zunehmend auch international das FLOT-Regime (5-Fluorouracil, Leucovorin, Oxaliplatin, Docetaxel) etabliert. Der prognostische Stellenwert der neoadjuvanten Radiochemotherapie bleibt anhand der gegenwärtig aktiven Studien abzuwarten. Bedeutung für die Entscheidungsprozesse im Tumorboard hat zunehmend der MSI-Status (Mikrosatelliteninstabilität) gewonnen, wobei Patienten mit MSI-Tumoren möglicherweise nicht von einer neoadjuvanten Chemotherapie profitieren. Patienten mit nur beginnend lokal fortgeschrittenen MSI-Tumoren (cT2, N0) oder solchen mit Komorbiditäten könnte eine neoadjuvante Therapie erspart bleiben. Die vorliegende Arbeit setzt sich kritisch mit den aktuellen „State-of-the-art“-Konzepten sowie den laufenden Studien zur neoadjuvanten bzw. perioperativen Therapie des Magenkarzinoms auseinander. Hierzu werden die wesentlichen, bereits publizierten und die aktiven Studien dargestellt.

Abstract

Neoadjuvant or perioperative therapy with radical surgery is a meaningful approach to improve the prognosis of gastric cancer. The FLOT regimen (5-fluorouracil, leucovorin, oxaliplatin, docetaxel) has been established as a perioperative concept in Germany and is also increasingly being used internationally. The prognostic significance of neoadjuvant chemoradiotherapy has to be awaited based on the results of currently active studies. The microsatellite instability (MSI) status has increasingly gained in importance with respect to decision-making processes in the interdisciplinary tumor board as patients with MSI tumors probably do not benefit from neoadjuvant therapy. Patients with only initial stages of locally advanced MSI tumors (cT2, N0) and those with comorbidities could be spared from neoadjuvant therapy. This article critically deals with the current state of the art concepts as well as with ongoing studies with respect to neoadjuvant and perioperative treatment of gastric cancer. For this purpose, the essential already published and the active studies are presented.

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Abb. 1

Notes

  1. Werden jeweils als ein inkurabler Organbefall betrachtet.

Abbreviations

AEG:

„Adenocarcinoma of the esophago-gastric junction“

AIO:

Arbeitsgemeinschaft Internistische Onkologie

ECF/ECX:

Epirubicin, Cisplatin, Fluorouracil oder Capecitabin

EORTC:

European Organization for Research and Treatment of Cancer

FLOT:

Fluorouracil, Folinsäure, Oxaliplatin, Docetaxel

MSI:

Mikrosatelliteninstabilität

MSS:

Mikrosatellitenstabilität

PCI:

Peritoneal Carcinomatosis Index

TCGA:

The Cancer Genome Atlas

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Authors and Affiliations

  1. Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland

    Ines Gockel MBA

  2. Universitäres Krebszentrum Leipzig (University Cancer Center Leipzig, UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    Florian Lordick

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Correspondence to Ines Gockel MBA.

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Interessenkonflikt

F. Lordick gibt an, Forschungsunterstützungen von BMS, Celgene und Roche erhalten zu haben. Er war als Berater für Amgen, Astellas, Bayer, Biontech, BMS, EliLilly, MSD und Roche tätig. Er erhielt Honorare für Vorträge, Publikationen oder Gutachten im Auftrag von AstraZeneca, Amgen, BMS, EliLilly, Elsevier, Infomedica, Medscape, Merck, MSD, Promedicis, Roche, Servier, Springer Nature und Streamup! I. Gockel gibt an, Referentenhonorare und Reisekostenerstattungen von Merck, Roche, Promedicis, Falk Foundation, Springer Nature und Ethicon Johnson Johnson erhalten zu haben. Sie hat außerdem Beraterhonorar von der Firma Roche erhalten.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Gegenwärtig aktive Studien sind im Text in fetter Schrift gekennzeichnet.

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Gockel, I., Lordick, F. Neoadjuvante Chemotherapie beim Magenkarzinom. Vielfach eine Übertherapie oder ein sinnvolles Konzept?. Chirurg 91, 384–390 (2020). https://doi.org/10.1007/s00104-020-01141-7

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