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Neoadjuvante und perioperative Therapie des Magenkarzinoms, aktuelle Studien und neue Biomarker

Neoadjuvant and perioperative treatment of gastric cancer, current studies and new biomarkers

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Zusammenfassung

Perioperative Chemotherapie ist nach aktuellen deutschen und europäischen Therapieleitlinien empfohlener Standard bei lokalisierten Magenkarzinomen jenseits der Frühkarzinome, also ab Stadium IB (T2 N0 M0 und T1 N1 M0). Für Patienten, die eine intensive Chemotherapie tolerieren, werden je 4 Zyklen des FLOT-Regimes (5-Fluorouracil, Folinsäure Oxaliplatin, Docetaxel) prä- und postoperativ empfohlen. Lokal fortgeschrittene, nicht fernmetastasierte Adenokarzinome des ösophagogastralen Übergangs (AEG) sollen wie Magenkarzinome mit einer perioperativen Chemotherapie behandelt werden oder alternativ mit einer neoadjuvanten Radiochemotherapie. Laufende Studien klären die Frage nach dem zu favorisierenden Vorgehen bei AEGs. Die Empfehlung einer perioperativen Therapie gilt für alle histopathologischen Subtypen des Magenkarzinoms. Der Beitrag fasst die aktuelle Datenlage zusammen und gibt einen Ausblick auf aktuelle Entwicklungen auf dem Gebiet der medikamentösen perioperativen Therapie.

Abstract

According to current German and European clinical practice guidelines perioperative chemotherapy is the recommended standard of care for localized gastric cancer beyond early cancers, i.e. in stage IB (T2 N0 M0 and T1 N1 M0) or greater. For patients who are able to tolerate intensive chemotherapy, the FLOT regimen (5-fluorouracil, folinic acid, oxaliplatin, docetaxel) should be administered preoperatively and postoperatively for four cycles each. Locally advanced nonmetastatic adenocarcinoma of the esophagogastric junction (AEG) should be treated with perioperative chemotherapy as for gastric cancer or alternatively with neoadjuvant chemoradiotherapy. The best approach for AEG is currently being investigated in ongoing clinical trials. The recommendation of perioperative treatment applies to all histopathological subtypes of gastric cancer. The article summarizes the contemporary data and provides an outlook on current progress in the field of medicinal perioperative treatment.

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Authors and Affiliations

  1. Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsmedizin Leipzig, Liebigstr. 22, 04103, Leipzig, Deutschland

    G. Stocker & F. Lordick

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

    G. Stocker & F. Lordick

  3. Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, Leipzig, Deutschland

    R. Thieme

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  1. G. Stocker
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Correspondence to G. Stocker.

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Interessenkonflikt

G. Stocker, R. Thieme und F. Lordick geben an, dass kein Interessenkonflikt besteht.

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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I. Gockel, Leipzig

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Stocker, G., Thieme, R. & Lordick, F. Neoadjuvante und perioperative Therapie des Magenkarzinoms, aktuelle Studien und neue Biomarker. Chirurg 92, 499–505 (2021). https://doi.org/10.1007/s00104-021-01355-3

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