Zusammenfassung
Hintergrund
Biliäre Tumoren gelten trotz einer steigenden Inzidenz weiterhin als seltene Tumorentität. Aufgrund eines oft lange klinisch inapparenten Verlaufs und wenig etablierter Strategien zur Früherkennung ist zum Zeitpunkt der Diagnose häufig bereits eine chirurgische Resektion nicht mehr möglich, sodass systemische Therapiekonzepte im Vordergrund stehen. Seit 2010 gilt die Chemotherapie mit Gemcitabin und Cisplatin als Standard in der palliativen Situation. Erst kürzlich wurden einzelne Studien publiziert bzw. initiiert, die die Therapieoptionen in der Erstlinie erweitern und erstmalig auch in der zweiten Linie valide systemische Ansätze zur Verfügung stellen.
Schlussfolgerung
Neben klassischen Chemotherapiekombinationen rücken zunehmend molekulare zielgerichtete Konzepte in selektionierten Patientenkollektiven in den Vordergrund; Neben den IDH1-Mutationen und den FGFR2-Fusionen bei Patient*innen mit intrahepatischen Tumoren sollten auch seltenere Alterationen wie eine HER2/neu-Amplifikation/-Mutation, NTRK-Fusionen oder BRAF-Mutationen in der Therapieplanung berücksichtigt werden. Die aktuelle Studienlandschaft verdeutlicht, dass die Präzisionsmedizin einen hohen Stellenwert in der Therapie biliärer Tumoren einnehmen wird und unterstreicht die Bedeutung einer frühzeitigen tumorgenetischen Diagnostik. In diesem Artikel wird eine Übersicht über die systemischen Therapiekonzepte in der adjuvanten und palliativen Therapiesituation gegeben.
Abstract
Background
Despite an increasing incidence, biliary tract cancer is still rare. Due to an often long clinically inapparent course and the lack of early detection strategies, surgical resection is often not feasible at the time of diagnosis. Since 2010, chemotherapy with gemcitabine and cisplatin has been considered standard of care in the palliative situation. Only recently, individual studies have been published or initiated that expand the treatment options in the first line and, for the first time, also provide valid evidence for second-line treatment.
Conclusion
In addition to classical chemotherapy combinations, molecular targeted approaches in selected patient populations are increasingly used; besides IDH1 mutations and FGFR2 fusions in patients with intrahepatic tumors, rarer alterations such as HER2/neu amplification/mutation, NTRK fusions or BRAF mutations should also be considered in treatment planning. The current study landscape highlights the importance of precision medicine in the treatment of biliary tract cancer and underlines the importance of early genetic testing. In this article, we provide an overview of systemic treatments concepts in the adjuvant and palliative settings.
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A. Vogel: Honorare für Referenten‑, Berater- und Beiratstätigkeit: Roche, Bayer, Sanofi, BMS, Lilly, Novartis, EISAI, AstraZeneca, Merck, Medac, Ipsen, Pierre Fabre, MSD. A. Saborowski: Honorare für Referenten‑, Berater- und Beiratstätigkeit: Roche, BMS, Servier.
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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Die Autoren Arndt Vogel und Anna Saborowski haben zu gleichen Teilen zum Manuskript beigetragen.
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Vogel, A., Saborowski, A. Aktuelle Systemtherapie für fortgeschrittene biliäre Tumoren. Onkologe 28, 287–298 (2022). https://doi.org/10.1007/s00761-022-01115-w
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DOI: https://doi.org/10.1007/s00761-022-01115-w
Schlüsselwörter
- Cholangiokarzinom
- Gallenblasentumoren
- Chemotherapie-Schemata
- Präzisionsmedizin
- Molekulare zielgerichtete Therapie